Co-Designing a Healthy Future with Foster Youth and Families

David* is a foster youth alumni living in Washington, D.C. When he was eight years old, a neighbor saw him running in the street and called Child Protective Services. David was placed in foster care, and for the next ten years, he bounced from home to home, eventually losing faith in finding a permanent family, or being reunited with his biological caregiver. When he aged out of foster care at age 18, he didn’t know how to pay bills, look for an apartment, or apply to college. He wanted to learn, but he didn’t have a family to lean on for support and felt totally overwhelmed.

David was on his own, like another former foster youth named Janet.* Janet entered care at age ten in Los Angeles and languished there, cycling through 10 different foster and group homes. After aging out of care, she was accepted to college. However, Janet didn’t have a family to walk her through the application process. When she showed up at school, she was surprised to learn that she was supposed to apply for housing in advance. There were no more dorm rooms available. Feeling defeated, Janet went to a homeless shelter and dropped out of school. Thousands of foster youth emancipate from the system every year and face similar challenges to David and Janet.

Last year, a team of Presidential Innovation Fellows collaborated with the Administration for Children Youth & Families to use human-centered design and agile methodologies to identify how the federal government could support states and counties in improving outcomes for youth and families who touch the system.

Did you know that every 2 minutes, a child in the United States enters foster care? There are currently more than 400,000 children in the system. Did you know that 60–85% of children are removed from their homes and placed in foster care due to neglect, a broad term that includes many conditions that stem from poverty?

Did you know that children who leave foster care have higher rates of PTSD than war veterans returning from Afghanistan? Or that 1 in 3 foster youth will experience homelessness in their lifetime or that 80% of former foster males will be arrested by their mid-20s?

We didn’t until we started this project, and we wanted to know why the current implementation of foster care isn’t producing more positive outcomes for the people it serves.

Human-centered design, a framework applied to service design and user experience that captures user input and feedback throughout the design process, is increasingly being used in the public sector to improve the citizen experience by working directly with citizens themselves. In the private sector, businesses that are considered “design driven” by the DMI outperformed the S&P 500 by 211% from 2005–2015. To improve efficiency and effectiveness, it makes sense to apply this methodology to government services.

During the Obama Administration, human-centered design could be found in places like the Veterans Affairs Center for Innovation, the State Department Collaboratory, the Lab at the Office of Personnel Managementand the Health and Human Services Idea Lab. Even former Surgeon General Vivek Murthy had an IDEO designer on staff.

For our effort with ACYF, we spoke directly with stakeholders in the system, including former foster youth and families who have been part of it, staff, providers, community leaders, and more.

Our research included interviews with hundreds of stakeholders, including youth like David and Janet, as well as subject matter experts, five child welfare agency visits across the country, three design thinking workshops with child welfare stakeholders, three conferences, two CPS ride alongs with social workers (an emergency nighttime ride in Los Angeles and a daytime ride in Washington, D.C.), and participation in the first ever White House Foster Care Hackathon in May of 2016.

Here are a few things we learned and made along the way:

#1. Upstream intervention saves lives and dollars.

As stated earlier, the current outcomes for youth who enter foster care are not good: they are 5x more likely to have PTSD than their peers outside the system, 1 in 3 experience homelessness, and they have higher rates of substance use disorders, unemployment, teen pregnancy, and incarceration than the general population. Most of these children come from low income families, and there are disproportionately high rates of minorities, due to implicit bias and the inequitable intersection of race and socioeconomic status caused by generations of institutional racism.

One analysis found that for every $1 invested in behavioral health prevention, $7 tax dollars are saved. Child welfare is a $33 billion system that produces the same outcomes year after year. If we shift some of that $33 billion towards prevention, specifically investing in things like mental health services, substance abuse treatment and parent mentorship, we would ultimately have fewer children in the system and require fewer tax dollars to sustain it.

Here is a video about the benefits of upstream intervention we made to help explain the importance of investing in prevention.

#2. Innovation is happening … but in silos.

There are many brilliant people working on the pervasive systemic issues that lead to negative outcomes for children in foster care, and we’re going to look at a few technology examples. Studies have found that the more caseworkers children have, the less likely they are to find a permanent home. Technologists like Abraham Ray from Microsoft are using their expertise to improve data analytics and business process performance and increase the efficiency of providers which will inevitably lead to less caseworker burnout. Ray’s team at Partners for Our Children in Seattle developed a suite of products called Oliver that are now being implemented in the state of Washington.

Another crucial issue is wellbeing. It’s one of the three core tenets of child welfare practice along with safety and permanency, yet there’s no standardized definition or metric to measure it. When we asked agency staff how they define wellbeing, we heard a lot of different answers.

You can’t measure what you can’t define.

Enter the Wellbeing Indicator Tool for Youth (WIT-Y), a product developed by researchers at the University of Minnesota and Anu. It’s a qualitative feedback tool that captures wellbeing data directly from youth and helps caseworkers and youth set realistic, achievable goals together to reach greater wellbeing.

Youth like David and Janet who aged out of care will likely tell you that they did not develop autonomy during their time in the system. It was a common theme in our interviews with foster youth alumni. Their bills were paid for them, their meals were provided, and decisions were made on their behalf without their input. This unfortunately meant that they did not have the opportunities to learn important decision making and life skills. “This is why so many of us end up homeless,” said David. “Y’all say we’re ‘handicapped’ but it’s the system that does it. It does everything for us and we don’t know how to take care of ourselves when we leave.

The Think of Us platform. Click on the image to view the MVP demo.

We frequently used the term “agency” when referencing child and youth development throughout this project. When we used it, we were referring to this definition: “Human agency is the capacity for human beings to make choices, and have the condition, or state of acting or of exerting power.” A sense of agency is important for human development, which is why Sixto Cancel, founder of Think of Us, and his talented team created an evidence-informed coaching app to help foster youth develop important life skills and make the transition to adulthood less overwhelming.

Technology is not the sole cause of negative outcomes for youth in the foster system, but it’s an important tool for improving them, as seen in the examples above. As a step toward bringing child welfare technology innovations together, and to share whatever open source projects exist, we built a child welfare product hub using USDS web design standards where the most innovative child welfare tech products can live.

The product hub was built for Federalist, an open-source platform developed by 18F that makes it faster and cheaper for agencies to build and host static websites that are secure, responsive, and accessible. The hub is currently looking for a home after the presidential transition. Contact Wendy at wendy.harman@pif.gov if you’d like to learn more.

#3. Client-centered support, not stigma.

Social work is hard — really hard. We learned that firsthand and spoke with many social workers who would love to prioritize the wellbeing of their clients, but cannot because they are overburdened by paperwork. On average, social workers spend 60–80% of their time doing reports, which is time they could be spending with families in the system. By design, compliance to system regulations is prioritized over wellbeing, but that can change by reducing burdensome paperwork with technological advancements and re-focusing on a client-centered practice.

The goal of human-centered design is to design with and not for. It would be difficult to find a successful product or service created in the private sector that was made without collecting any user input or feedback. The design driven companies that outperformed the S&P, like Apple, Honeywell, and GE, are constantly capturing user feedback, and tracking and analyzing real time user data to make the implementation of their products and services better. This can and should be done more regularly in the public sector through the use of user-appropriate surveys performed at point-of-service.

We learned a lot from the families and youth we spoke with and surveyed during this project. Families requested support and not stigma: upstream support to strengthen their families and prevent their children from being removed, parent partners to provide mentorship if their kids are removed, and peer mentors for youth who can provide continuous guidance about the system and answer questions. Who better to have empathy and understanding for the families and youth in child welfare than people who have experienced the system firsthand?

Too often in the past, families and youth were not consulted about their own case plans or even provided clear information about what was happening to them. Parents requested to be treated as partners, and wanted to be included in the development of their reunification plans. At every step of the way, they would like their interactions with the system to inform and encourage them to meet goals and deadlines to help them get their kids back. Some agencies, like the Allegheny County Department of Human Services in Pittsburgh, use a conferencing and teaming model where families and staff make plans and decisions together.

Children and youth would also benefit from increased transparency and voice. The ones we interviewed requested frequent communication about key decision making points, as well as clarity around the consequences for any decisions that they are allowed to make themselves to help them think through what would be best for them.

To pull all of our insights together, we created a foster youth experience map. Customer “journey” or “experience” maps are used in the private sector to breakdown service touchpoints from the customer’s perspective and identify what’s working well (positive points), what’s not working well (pain points), and opportunities for improvement.

We worked with a team of foster youth and staff at D.C.’s Child & Family Services Agency to create FYX, a Foster Youth Experience map that depicts universal journey points in the child welfare and foster care system from the foster youth’s perspective. It’s an empathy-building tool that shows a snapshot of what youth experience in care. At each journey point, our CFSA task force suggested opportunities to strengthen families, and build youth agency.

You can download the map and user guide by clicking here.

It was a true honor to work on a project for foster youth in the United States with the Administration for Children, Youth & Families. This is an important issue and we hope to see it continue to receive the attention it deserves, and the transformation necessary to provide youth and families with more support and skills than they had before entering the system.

Each of us on the child welfare PIF team had a personal stake in this project: Wendy was in the process of becoming a foster parent, Puja was a young person herself who had recently spent a year working on youth voice projects in India, and Emily is now in Pittsburgh working for the Allegheny County Department of Human Services as a civic designer in the inaugural Foster America cohort.

From the bottoms of our hearts, thank you to the youth and families who were willing to share their stories and insights, The Administration for Children, Youth & Families for their guidance, The Child & Family Services Agency task force led by Kevin “Scooter” Ward for their expertise, the child welfare agencies in Allegheny County, Los Angeles County, Oklahoma City, and Baltimore for their time and insights, and all of the amazing stakeholders and innovators we met along the way. If you helped with this project and you want to be recognized, leave a comment on this post, share it, and explain how you were involved.

Foster America is actively seeking applicants for the second cohort of fellows, with an application deadline of June 15, 2017 and a number of upcoming webinars to learn more about the opportunity and the selection process. See www.foster-america.org for details.


Emily Ianacone is part of the inaugural cohort of Foster America using human-centered design at the Allegheny County Department of Human Services. Wendy Harman is a Presidential Innovation Fellow working with the National Cancer Institute. Puja Balachander is a social designer for the World Bank in Madagascar. You can tweet at them here: @myfriendemily, @wharman, @pujabalachander.

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