by Rose Hoban, North Carolina Health News
March 22, 2019
By Rose Hoban
Once again, glitchy computer programs are creating headaches for the North Carolina Department of Health and Human Services and social workers across the state.
For many people who work in county social services departments , the culprit is a familiar one: NC FAST.
In 2013 and 2014, problems with implementing the computer system caused massive delays for families receiving Supplemental Nutrition Assistance Program benefits (formerly known as food stamps). Those software problems put the state at risk of losing federal funding for the entire SNAP program. Later in 2014, NC FAST caused a backlog of tens of thousands of Medicaid applications, again calling down the wrath of federal officials.
The issues were eventually resolved, but this week, NC FAST (short for Families Accessing Services Through Technology) was in the spotlight again, as lawmakers heard from DHHS’ child welfare program leaders about problems with the children’s services pieces of the program. A rollout of parts of NC FAST was supposed to help county social workers track children and troubled families through the social services and foster care systems. Instead, county social service directors told lawmakers about mass resignations of staff who cite their frustrations with NC FAST as part of the reason for heading out the door.
And the choices lawmakers need to make about how to address the problems will likely cost tens of millions of dollars, no matter how the state proceeds.
NC … SLOW?
The need for better tracking of families involved in the child welfare system was one of the reasons that North Carolina failed reviews by the federal Children’s Bureau and a private audit in 2016.
Two decades into the age of the Internet, most county DSSs still use paper files to keep records about child abuse, neglect and the services they receive. Social workers lack the basic ability to track troubled families with vulnerable children who may move across county lines. They also can’t access criminal records. The two reviews cited this lack of data, the inability to track where families are, and an inability to find children who fall through the cracks.
These pitfalls in the system were highlighted by the case of 3-year-old Rylan Ott, whose tragic 2015 death in Moore County inspired an eponymous law intended to overhaul the child welfare system.
NC FAST was created to provide a common platform for all of social services, from Medicaid eligibility to tracking troubled families and have all the information in one place.
Matt Salo from the National Association of Medicaid Directors said that issues with software packages for big state programs are a common complaint across states.
“When we convene members … the IT stuff is always in the ‘I’m really frustrated by this’ category,” Salo said. “In every single state, whenever they do this, there are delays, cost overruns and by the time the whole thing is built some portion of it is outdated.
“Nobody’s got an answer.”
Despite those initial glitches and crashes, the systems for SNAP and Medicaid eligibility slowly improved. So, in 2015, state officials decided to move ahead with developing NC FAST modules to track children and families in the child welfare system. Work started in 2016.
An original five pilot counties started using the system in August 2017, among them was Sampson County, where Sarah Bradshaw is the director of social services.
She told NC Health News that in the first six months of deployment, she had a 60 percent turnover of her social work staff of about 40 workers.
“I cannot say that everyone leaves saying it was because of NC FAST. They don’t communicate it exactly that way,” Bradshaw said. “Seeing their tears and seeing their concerns we know that it doesn’t work for them and is causing frustration.”
The problems with the rollout were profound enough that DHHS delayed statewide deployment and added another six counties to the pilot program while they worked to get a fix.
“We went back to IBM … and said, ‘You all need to help us make the system better, and you need to do it for free, we really need you to do some work with us,’” DHHS’ Susan Perry-Manning told lawmakers. “We leaned heavily on them, we leaned heavily again on our pilot counties to help us with a redesign.”
But according to DSS directors who spoke up at the Joint Health and Human Services Appropriations committee meeting on Tuesday morning, NC FAST has continued to frustrate.
“We were promised a dashboard so that we could manage the work, that we were promised 24 hour, seven days availability,” Heather Skeens, the DSS director from Guilford County told lawmakers. “Those were the commitments that were made to us from the beginning, which is why I volunteered to be a pilot county and why I fully endorsed NC FAST and that was in 2016.”
“Since 2016, I had a 75 percent turnover in my social work staff, I had 11 resignations on the first of March all citing NC FAST. I have foster care reimbursements that have not been paid since August of 2017. The data is not accessible.”
Thus far, the creation of the child welfare part of the system has cost $92 million with $42 million of that from the state and the remainder in federal dollars. And the budget calls for another $11 million in spending, with $5 million of that coming from the state.
DHHS and the pilot counties have been working with IBM to redesign the system, said Perry-Manning, and the newly redesigned intake and assessment portions went live in 19 counties in January.
If North Carolina decided to abandon this portion of NC FAST, Perry-Manning told lawmakers, the state would be on the hook for repaying the feds that $52 million and would be left to start from scratch, a process that could take years.
However, slowing down implementation to work out all the problems would cost about $1.5 million per month.
“I think with the redesign work that we’ve done so far, we are very close to having a usable product that places a reasonable amount of effort on counties, but not undue effort on counties,” Perry-Manning told NC Health News. “That said, I think the counties would, in fairness, have a different view right now.”
She admitted that there would always be some level of data entry to be done by county workers, which was one of the main complaints coming from DSS directors.
“It would be unfair to suggest that this particular technology product is ever going to operate like Facebook, or Amazon operates,” Perry-Manning said.
She argued that there’s been “a total redesign of the program,” and the bits that went live in January take some getting used to for the 23 counties that had previously only kept paper records.
“Imagine going from paper-based to where you have to enter everything into the computer,” said Susan Osborne, Assistant Secretary for County Operations for Human Services at DHHS. Osborne herself weathered issues with NC FAST’s troubled SNAP rollout while she was the DSS director in Alamance County, so she has been key in reassuring county DSS directors during the recent implementations.
Not every county director is unhappy. Crystal Mitchell from Orange County rose to tell lawmakers on Wednesday that her staff “enjoys” using NC FAST and that she’s seeing benefits in her department.
“A couple of those benefits include transparency and data visibility,” she said during the appropriations committee meeting’s public comment period. “We’ve been able to see the benefits of that with other counties that are in NC FAST, with families that have moved away from Orange County or they have history in other counties, that data is at our fingertips.”
Mitchell acknowledged some of the problems with the system, and the need for improvement.
“We would be remiss if we did not acknowledge NC FAST’s willingness to partner with us, the Division’s willingness to partner with us, to hear our feedback, we feel like that feedback has been considered,” Mitchell said. “There’s been redesign that’s occurred within the system and we’ve been impressed with that redesign.”
Perry-Manning seems to have convinced lawmakers for the time being to keep moving forward. On Wednesday, a bill that would have suspended development of the child welfare portions of NC FAST was amended to delay any further rollouts until October.
“I think we are within striking distance of making this system workable,” she said.