Stuck On Social Work

Algorithms are playing an important role in our daily lives. They tell us what to shop for, they decide if we get a loan, and coming soon how we make healthcare decisions. These could have significant implications for social work practice. Learning about concepts such as algorithms and artificial intelligence is a part of my journey of trying to get “unstuck” about technology issues. I set out to get clarity on algorithms and how social workers can gain a voice in their design. It’s important back up just a bit and define what they are…

I found this one minute video via BBC Learning to sum it up nicely…

This illustrates the need for algorithms to be clear, concise, and accurate. As algorithms, machine learning, and other forms of artificial intelligence get into more complex problems, this gets tricky. For social work practice the question is not “if” algorithms will impact our practice but “when” and “how”. This post was inspired by a medical blogger, Dr. Berci Mesko aka “The Medical Futurist”. He consistently explains how technology will effect medical care.

In a recent post he explains the medical algorithms currently approved by the Food and Drug Administration (FDA) in the United States. This provides an excellent overview of what algorithms are used for in medicine. What caught my eye is the four highlights as being relevant to psychiatry.

Cognoa’s algorithm built into an app helps diagnose autism in kids.
ReSET-O offers an adjunct treatment of substance abuse disorder.
QbCheck helps with the diagnosis and treatment of ADHD.
Cantab Mobile acts as a tool for memory problem assessment for the elderly.

My enthusiasm for technology has been tempered over the last year as I learn more about algorithms and machine learning. I recently reviewed and read “Weapons of Math Destruction” about the potential faults of algorithms. That algorithms determining teacher evaluations, college rankings, and criminal justice sentencing are inherently biased. Social workers should be aware of potential biases in these systems. What I struggled to find was a way to analyze these issues in a concise way.

I began to to question concerns about medical algorithms and my twitter crew came through…

Those four algorithms for psychiatry are possible signposts. If the FDA approval is based on relative accuracy comparison by humans (example, ADHD), I have questions, but not necessarily surprised.— 𝗦𝘁𝗲𝗽𝗵𝗲𝗻 𝗖𝘂𝗺𝗺𝗶𝗻𝗴𝘀, 𝗟𝗜𝗦𝗪 🎙💻 (@spcummings) June 18, 2019
Along with (for some of these) who gets the data, what else is data used for, is there any kind of auditing…
— One Ring (doorbell) to surveil them all… (@hypervisible) June 18, 2019

Hard to say w/o more detailed breakdown, but one issue is definitely the “usual” question: what populations were used to train the algos?
— One Ring (doorbell) to surveil them all… (@hypervisible) June 18, 2019

The most helpful resource I found was provided by Dr. Laura Nissen. She found the AI Blindspot by the MIT Media Lab and others…

Ok that is completely fascinating and I don’t have complete answers. So far I’ve found 2 things I like that seem like promising scaffolding to decide “do I like this?” Or “ do I not like this?” Here’s one of them… https://t.co/4ELcqsBRv3— Laura Nissen, PhD, LMSW (@lauranissen) June 18, 2019

They walk you through the process of potential errors in building AI and algorithms. The provide a series of cards that gives examples of each error. They provide further resources…

I found the card on “Representative Data” to best capture my initial concerns about data diversity. That in healthcare we want to be concerned about making sure that diverse data sets are available. From the social work perspective two more notions of algorithmic justice are important.

The concept of Discrimination by Proxy is a critical one. This means the algorithm may “have an adverse effect on vulnerable populations even without explicitly including protected characteristics. This often occurs when a model includes features that are correlated with these characteristics.” An example that I have heard about is algorithms that decide criminal justice sentencing. That correlated concepts such as race and socio-economic status will determine sentencing rather than other factors.

Also important to social workers should be the Right To Contest. If one of these common blindspots are found, there is a means to reconcile this. Is there enough transparency in the algorithm to fix “the problem. This is important when thinking about empowering the individuals and families we serve.

As decisions continue to be made more and more by algorithms, I found this frame work to be helpful in thinking critically about this. This provides a helpful overview of these issues and hope that it too gets you “unstuck” about algorithms.

Design Thinking is a design methodology that provides a solution-based approach to solving problems. It’s extremely useful in tackling complex problems that are ill-defined or unknown, by understanding the human needs involved, by re-framing the problem in human-centric ways, by creating many ideas in brainstorming sessions, and by adopting a hands-on approach in prototyping and testing.

https://www.interaction-design.org/literature/article/5-stages-in-the-design-thinking-process

I have been meaning to write about design thinking and it’s relationship with social work for a long time. I have finally found my muse! This week I have attended what has been a series of training it what is called “High Fidelity WrapAround” or WrapAround. The history of this evidence based practice is long but in it’s current form it is based out of the work of the National WrapAround Initiative (bonus: based out the University Of Portland School of Social Work) and the National WrapAround Implementation Center (also bonus: based at the University of Maryland School of Social Work) . The focus of WrapAround is a team-based and family centered approach to working with youth at risk for out of home placement. It was formed on the need to reduce the amount of youth in residential care and improve their outcomes. This is a detailed training of 2 days per month for 7 consecutive months.

It does contain it’s share of buzz words like “Family Voice and Choice” and “Strengths Based” but putting these and the other eight core principles can provide something different to high risk families. It’s difficult to do this model justice in a blog post but think about an intervention that you use that truly incorporates at least 5 of these principles at once….

What is unique is the training cohort has a mix of community based providers and residential treatment providers. We talked about “the problem” of transitioning youth from community based care to residential and vice-a-versa within WrapAround. The model is reliant on building natural and community based supports. This is frequently a challenge for youth in residential care. However getting multiple stakeholders involved in the extended training proved to create a learning collaborative.

Design Thinking has been increasingly popular term on how to re-imagine both healthcare and mental health services. What I found was we fell into design thinking by accident and it was powerful.

A discussion about crisis plans for youth became a conversation about empathetic design. How can we design programs to be more team-based and family-centered in our practice? The “human-centered” core of WrapAround lends itself to the design thinking process…

https://www.interaction-design.org/literature/article/5-stages-in-the-design-thinking-process

In thinking about the design process for mental health services, we design our programs around paperwork and regulation. In residential care the first 72 hours of admission there is a lot of paperwork to get done for reimbursement and regulation. The same holds true for the first 30 days of outpatient or community based programs.

If we put the billing and regulatory requirement off the side for a moment, how could we make the admissions process truly family, client, and team driven? Leaders in the residential space started to think about how we can redesign to the family and team in front (and of course get our paperwork at the same time). The crisis plan was historically done by a “crisis worker” in isolation with the client. Participants started to think how this “check box” doesn’t need to be in the domain of the “crisis person”. This form could be completed by the family and the entire team.

Leading with empathy, redefining “the problem”, helped us create a new idea. From this we can create a prototype that gives the paperwork a little more meaning and experience. Social Workers live in world of increasing demands from regulators and payers. Seems like there is just another form to fill out every week. The challenge is how can we design paperwork and programs that provide meaningful experiences. That redefining “the problem” to include clients and families leads with empathy.

How can we design treatment plans that not just have goals that meet requirements but actually mean something to clients?
Can we create an “empathetic” incident review?
In what ways can we make our intake process less about check boxes and more about therapeutic work?
Can you redesign programs that put families first?
Where can we deploy technology to be more family-centered?

As social workers we unconsciously think this way all the time. We would like to think we are being “empathetic”. I would challenge us to examine our program designs. Are we truly being empathetic to the individuals and families we serve or are we just hitting the required check boxes. These are some of the challenges that design thinking can assist with? I saw design thinking creep into a evidence based practice. Where else can you find it?