Tristan Louis and Sixto Cancel on Bringing Technology to Child Welfare

Posted November 30, 2018, By Lisa Hamilton

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Tristan Louis and Sixto Cancel

Interviewee:

Sixto Cancel is the founder and CEO of Think of Us, which leverages technology to support young people in foster care. The company’s app connects foster youth with key resources — including a digital advisory board of caring adults — while also collecting data on the supports and services that its young users really need. Cancel also serves as a Jim Casey Young Fellow.

Tristan Louis serves as the president and CEO of Casebook PBC, a company originally incubated by the Annie E. Casey Foundation. Today, Casebook PBC produces software that aims to help human services professionals make smarter, faster decisions for families in their care while also lightening their administrative load.

The first thing that we've learned is that there are pretty bad solutions out there that are not meeting [the needs of] caseworkers.

–Tristan Louis

How do we help people develop abilities and then how do we position them to thrive?

–Sixto Cancel

Show Notes

On any given day in America, the nation’s child welfare community tops 440,000 kids, according to the Children’s Bureau’s 2018 AFCARS report. This population — which has grown every year for the last five years — moves through a system that is largely overburdened, inefficient and underfunded.

In this podcast episode, the Annie E. Casey Foundation’s Lisa Hamilton interviews two leaders — Casebook PBC President and CEO Tristan Louis and Think of Us Founder and CEO Sixto Cancel — who are working to change this landscape. 

Their catalyst of choice? Technology.

Original theme music composed by Stephen R. Frank at Baltimore Studios.

View Transcripts

Lisa Hamilton:
From the any Casey Foundation, I'm Lisa Hamilton and this is Casey Cast.

At the Casey Foundation, we work to build a brighter future for children and families. Increasingly, technology and innovation play important and evolving roles in this work.

Today we'll talk with leaders from two organizations who can speak to how cutting-edge tools helped to improve human services systems, as well as the lives of the children and families they serve.

The first organization Casebook PBC has deep Casey Foundation roots and I'm fortunate to sit on its board. Originally incubated by the Foundation, Casebook PBC developed an innovative software platform called Casebook that helps human services systems track and improve results for the children and families they serve. Joining us is Casebook PBC president and CEO, Tristan Louis. Welcome, Tristan.

Tristan Louis:
Thank you, and it’s a pleasure joining you here.

Lisa Hamilton:
We are also joined today by Sixto Cancel the founder and CEO of Think of Us. Think of Us has developed an app that helps foster youth build their own network of supportive adults. This app also collects valuable data about decisions and services related to the youth in care.

I should also add that Sixto is no stranger to the Casey Foundation. After spending time in foster care, he has worked with the Casey Foundation for the last eight years, serving as a young fellow for the Foundation's Jim Casey Youth Opportunities Initiative. Welcome, Sixto.

Sixto Cancel:
Thank you, Lisa. I'm so glad to be here.

Lisa Hamilton:
Wonderful. Well, why don’t we get started by talking about what your software solutions do? So, we'll start with you Tristan, what is Casebook and how is it improving the ways that kids and families have been traditionally served?

Tristan Louis:
Thank you for asking, Casebook is set of tools that are put together in what we call a platform, that aim that's replacing all the capabilities, the software capabilities of a modern human services agency. Basically, from the time a call comes in into, say, an emergency hotline or 911 center, and information has to be entered into a computer system, leading to something like an investigation, if the allegations are to be substantiated or unsubstantiated, and then going into identifying providers, or identifying families, foster homes in which a child needs to be placed and licensing those individuals and then paying them. It does a complete set of tools that need to be built and managed to do that. And so, at Casebook, what we've done is that, we've taken a modern approach to really take care of, that whole infrastructure, the caseworkers don't have to deal with what had been mostly, either very antiquated computer systems. Systems that haven't been updated since the ‘90s, or even worse, paper-based type of systems where people are still taking notes on pen and paper dating back to the 19th century.

Lisa Hamilton:
What kinds of information does casebook tool gather and make available to a case worker and the child welfare system compared to the way that child welfare workers had to work with these old antiquated systems?

Tristan Louis:
So, one of the things that we capture pretty much every piece of information that goes around the case. If a case worker is working in the field and needs to have access to information on the case that, is new to them, they have access to the old information there. One of the things, one of the innovations that we brought to this field, is the idea that we're looking at it from a person-centric standpoint. When they're sitting across from that child or across from that adults that's related to that child in some way, shape or form, they have information about every other situation, where that adult or that child has been involved with the human services sector.

That data is useful in terms of providing them information very quickly about the setting that they are walking into, or the setting that they're in right now and making decision at a much faster rate in terms of what is the best type of intervention for that individual.

Lisa Hamilton:
They're looking at information from a child-centered perspective. And I understood in the past, a lot of times, systems were just focused on gathering data they needed to report to federal authorities. It really wasn't that data they needed to make better decisions for those kids.

Tristan Louis:
That's exactly the challenge, is that a lot of the traditional systems have looked at cases. And then in the category is even called case management, generally speaking, because people look at it as essentially a folder or set of folders. They cannot necessarily attach information from one particular case to what's happening in a different case, because of the way those antiquated systems are organized. And as a result, there's a whole history there that just does not happen. It's kind of groundhog days for all those people that are coming into the system. And because the work is hard, as you know, there's generally a fairly high amount of turnover among caseworkers. And so, the institutional knowledge is generally not there. It's trapped into those file folders. By taking that person centric type of approach. We actually bring all that institutional knowledge about that individual, back to the folder, and that allows the caseworkers to make much better decisions.

Lisa Hamilton:
It sounds like it's helping individual caseworkers make better decisions, does Casebook aggregate data in any way, that might help the whole system function better?

Tristan Louis:
That's the next step. We look then at aggregate data to instruct what kind of information we need to put in front of those caseworkers and in front of the administrators and in front of the leadership of an agency to then identify, what are the policies that work and what are the policies that may need some improvement.

Lisa Hamilton:
Give me an example of the kinds of better decisions you see happening for individual kids, and what kinds of decisions would you see happening at the whole system level for kids?

Tristan Louis:
So, for example, there, there were issues where caseworkers were so overloaded, that they did not spend time on putting the kid back in touch with their parents on a regular basis. And people in the child welfare system know that frequent contact with the parent is essential, if we don't want to create trauma. And so, by putting those kinds of indicators directly in the system as to the last time and the number of days since a child was last seen by his parents. We actually increase the amount of touch between a child and their parent and the amount of times that caseworkers ensured that kids would be visited by their parents.

In the same way, by attaching different components in the system and by treating the system as a person centric type of system, we started identifying linkages were none were known of before. We can connect that, grandparents has had maybe some children and they have had children that have time in system, we can then immediately draw that line from point A to point B from the child to the grandparent and say, okay, the child needs a house, that grandparent is in the process of being becoming a foster parent. We can immediately move that child and reunite that child with a member of their family.

Lisa Hamilton:
I understand that, the case book software was a product of, over six years of close partnership with caseworkers, what did you learn from working so closely with professionals in the field about how you needed to build this system?

Tristan Louis:
The first thing that we've learned is that, there are pretty bad solutions out there that are not meeting the requirements of those caseworkers. The other thing that we've learned, is that workers all always overloaded, I don't think there's the states around the county or there's caseworker around the country that goes, my workload is just fine. And unfortunately, the trends are not getting any better.

From there, we've actually started to identify areas where we limit the amount of work that our caseworker has to do, to get to the same information and to enter information into our systems. We're providing things like prompts as to the type of names that may be related to a case or prompts us to the information that they need to have right now in order to be able to progress their cases. Last but not least, we're also seeing massive work around duplication and duplication in two ways. One is that in a lot of systems, there is duplication of data.

So, we've seen situations in some states where, individual exists in, with eight or nine different names in a particular system, and that creates some issues as to which one is the right individual. We've seen issues also run duplication of effort, because then when you do, you cannot find that individual, you are re-entering all that information. And in a world where caseworkers are spending between 30% and 50% of their time on that administrative task. This is all work that takes away from caseworkers actually spending time with the individuals that they have to treat.

Lisa Hamilton:
Wow. Well, I appreciate that perspective on how the system works and what caseworkers are faced with and appreciate that insight into what casebook does in order to help give caseworkers better and more timely information. With that perspective, we're actually going switch to Sixto, who can give us a sense of a technology solution from a young person's point of view. So Sixto, I'd love to hear about Think of Us. What your app does and how it comes at helping young people from a different perspective than casebook.

Sixto Cancel:
Thank you, Lisa. We truly believe that we had to take a different point of view in creating any type of software. So many times, when we think of software in our field, we start to look at, what are the requirements, what are the RFPs, the request for proposals from states and organizations and we kind of threw all that out the window and we said, let's really start with the problem, and the problem that we began to dig into, is the idea that some young people need support when they're aging out of the foster care system. Not all young people who into foster care and they have gone back home or end up getting adopted. And at 18, in many different states, they end up having to figure out how to be completely self-sufficient.

And what we see, are negative outcomes. We see a 3% graduation rate from college, we see 20% homelessness, and then we see a 50% unemployment. And, so the outcomes are drastic. And for us, we started to understand that, when we look at all the logic models and all the evidence-based programs across the country that have done a great job with young people who are aging out of the foster care system, it's always been programs that really wrapped around that young person with intensive support. And the thing that we admire most about technology is that enable us to do 10 times what humans usually can do without it, right? When we think about those in a house, the fact that we have machinery that allows us to do 10 times quicker than, about, 50 years ago.

What we came up with was, an application that's a life coaching platform. The idea that at 14, you start to think about what's going to happen after foster care. What's going to be the thing I do, once I'm no longer in high school, and how do I actually start to be able to achieve that and we found that some of the most essential things were things such as, what you could do in our application, which is create a personal board of advisors, who are committed to staying with you from that 14 year old, from being 14 all the way through your transition.

Sixto Cancel:
And it's the first time, we're gathering young people who are where they can now collaborate with the paid professionals in their life like, a social worker psychiatrist or therapist, along with the unpaid people in their life. The people who just care about them and extend on, a teacher, a coach, people who are showing up for that young person.

Lisa Hamilton:
So, this puts young people in the driver's seat.

Sixto Cancel:
And together, that group gets to create that transition plan of what's going to happen after foster care, what are the goals? What are the next steps that needs to be taken to hit those milestones?

Lisa Hamilton:
How does this happen traditionally? Does a caseworker put that plan together or do young people typically drive that process in figuring out their plan after foster care?

Sixto Cancel:
I think we have seen some improvements from a traditional pen and paper process that social workers would go ahead and lead to. We have seen some pockets of examples, where social workers and counties are doing an immense effort to include young people in that process of creating a plan. However, what we saw was that, creating a plan about what's going to happen after foster care, it's just a living and moving breathing target. It's not the idea that one day out of every six months we're going to meet and we’re going to I know exactly what's going to happen. You need support at every single step of the way.

How do you rent that first apartment? How do you open up a bank account? How do you make a decision around classes, when you're registering for school? All of these things need other adults who are like family to us to be able to guide us and that’s what we’re providing through our application.

Lisa Hamilton:
Oh, that great. Tell me, Think of Us helps you pull the champions in your life together, but then how does it also help you solve these other challenges that you might have in your life?

Sixto Cancel:
One of the things, one of the places where young people spend a lot of time on our platform is called stories and advice. And that's where young people have, are able to watch content on the many different domains of life, from being able to watch content of how other falsies were able to navigate sibling relationships to actually managing your credit and opening up a bank account, creating your first resume.

Lisa Hamilton:
So, it gives them information as well, about how do address all these various aspects of life?

Sixto Cancel:
Yes. And there's additional features, such as the digital locker, where they can house their social security card and birth certificate and we partner with Box, to be able to create a very secure place that encrypted those documents. We also have the ability for young people to create their own budget because all of your goals are related to how you manage your money. And how is it that you have the resources or don't to be able to execute on those specific milestones.

Lisa Hamilton:
How do young people get access to Think of Us?

Sixto Cancel:
For right now, we've been partnering with certain agencies as we develop, because one of the things just like Tristan mentioned is that, what we wanted to do, was partner with the folks on the ground to co design a solution. When we thought about our journey here, we realized that it wasn't about making what I like to say like the better flip phone. For us, we were saying, what is a smartphone of about field. And what we realized is that the smartphone of our field is a piece of software that helps people heal by connecting them with support of adults who are there for them, who are rewiring that trauma of disconnection. That feeling of I'm alone in making these decisions. I'm alone as I navigate into adulthood.

Lisa Hamilton:
And, similar to casebook, this technology has been informed by your own personal experience is, in foster care. Could you tell us a bit about what led you to start that Think of Us and how your experiences informed the sort of functionality that you developed here?

Sixto Cancel:
Absolutely. Lisa, one of the things that I would say it's tough about foster care, is when you continuously move from one home to the next, the idea that you have to start over with a new home, new rules, new community, new school, new everything. But what worried me more at 15 was, what was going to happen when I wasn't even in a system. What was going to happen after foster care. I was fortunate enough to be part of Jim Casey's Opportunities Initiative, one of the programs is called opportunity passport. Or I had these paid professionals in my life, who taught me how to manage money, who taught me how to rent out my apartment to buy a car, but then when I went into my first semester of college, I was still connected to those professionals, but because I was not on their caseload, things were different. The way that folks respond to you when they have, it’s part of their job obligation, is completely different.

It was the first time that I realized that I had thought I had a lot of adult connections but unfortunately a lot of those adult connections were not a strong because they were all paid connections in my life. And so, for us at Think of Us, we started to think through, how is it that young people are able to build the relationships that they need to build with the unpaid people in their life? Because all the research points to that when we have that family and life network, supporting us in these decisions, supporting us in the moment of crisis, that our lives are much more likely to have better outcomes. We're much more likely to be connected to education and still be employed. And so, for me, it was how that experience of, Hey, I thought that the first one of navigating foster care, surviving kind of the abuse that I had survived, was the end of it, but yet it was the beginning of this second storm of, well, how are you going to prepare to be completely independent?

Lisa Hamilton:
So, Sixto given the powerful experiences you've personally had that inform the creation of, think of us. I'd love to hear how the app is helping young people, what kinds of differences it making in their lives?

Sixto Cancel:
The number one difference that I see is, connection. When we think about all the programs and we think about our application and what sets us apart. It's the idea that for the first time a young person is saying, “I want these folks in my life to work together with me and the goals that I have identified.” So, for example, we had a young man named Jay in the beginning days when we were co designing our prototype further, he was part of that cohort. And he was thriving. He was able to get a job, he was able to be stably house. However, the one thing that stood out to us was, when he said, “this is the first time I have people checking in on me, checking in on my budget, checking in on did I actually submit those resumes to the number of places we agreed on today.” It was a very different feeling for him because he was, chance to be part of that network. Wasn't just because you were a pay obligated person in my life, but it was the paid folks in the unpaid folks now, both telling me, “Hey, did you drop off those resumes?”

And so, that's one of the most significant things that I would say, makes us different and how we've been able to see impact.

Lisa Hamilton:
That's great. Given the kind of data you're collecting in the app, are you seeing ways that they could help not just individual young people, but help to improve the bigger system?

Sixto Cancel:
Yes. A lot of folks ask me like, why I am in tech because at the heart of everything, I'm a policy and practice nerd. And I love policy and practice and systems reform. And the thing that I love most about technology is that based on the behaviors of a user, it generates data that then we can begin to do things with and understand different things. So, for example, when a young person goes onto our platform and creates a goal and they add new folks to that goal to support them, that's new digital behavior and new data that we just don't have in child welfare right now, because we've never really put young people at the center of a tool and said, You drive the ship and then let them do stuff. So, we're able to start seeing hey, who are they adding? Is it mostly extended family? Is it people from different communities such as churches and school? We’re able to see what are the goals?

And the first 90 minutes of our platform, 62% the goals and Omaha, Nebraska, were all related to financial literacy or some type of purchasing an asset. And I believe that's a direct reflection of the immense work that goes on in that community around financial literacy for those young people who are aging out.

Lisa Hamilton:
You, both Tristan and Sixto, you are both extraordinarily creative and cutting edge in the work that you are doing often around improving child welfare systems. What other areas do you think are ripe for technology driven solutions just enough, I'll start with you, and then turn to you Sixto.

Tristan Louis:
We are going through a current curve where software is impacting just about everything these days. And so the question to us is not really, what is it going to change, but what is going to be staying there, what is not going to change when you use technology, because that's the first component that we have to put in place in terms of what was supporting and then layering the technology on top of that to solve real-world problem is really what matters, there isn't really a space of our economy or space of our society, where technology is not going to have an impact over the next five to 10 years.

Lisa Hamilton:
What you Sixto? What do you think? Are there particular areas you think are right for technology solutions?

Sixto Cancel:
Yeah. I think the particular area that technology solution should be used to disrupt is in the actual foundational design of our system. You know, in the mid 1800s, Charles Loring Brace started the foster, he is considered the father of the foster care system. He started the Orphan Train movement and this movement was taking children from inner city New York who are homeless to orphaned and placing them on farms in the Midwest. And this became the foundation of which our child welfare system was built on, which means that the principles of safety, security, a roof over your head, the exchange for food and living are those foundational things. One of the things that I feel in child welfare that's going on, is that because we started there, and now our new system requires a different approach to children and young people which is, how do we help young people heal? How do we help them develop different abilities? And then how do we really position them to thrive and then how do we do the same thing with the biological families that young people are coming from. Because that's a difference philosophy and system, technology has to be aligned with the new philosophies versus the old.

Because what we can do all day long is automate our current practices and our current processes and will only get to the broken results faster, because I believe that our system is just fundamentally designed wrong. We believe that the child welfare system is about changing children behavior sometimes, when it's really about dealing with the adults who caused the children to come into care the first place. How can we use technology to be able to influence new practice? Because right now our current case management systems, I believe they influence a compliance-based culture.

Tristan Louis:
I agree with Sixto that we definitely need to rethink how the whole system and when I say system, I mean, all the components from housing, to dealing with poverty, to workforce development, and so on and so forth, works to improve the lives of those children's and the lives of those families. Where, I think I may differ in my thinking of how to approach the problem is that, Sixto has a very clear point of view on this.

My view is that we will find the best practices from the data that is given to us by historical evidence that we've got. And so if we can structure this system in a way where we can capture the data in a consistent fashion across the whole country, and maybe eventually across the world as a whole, we can start identifying which are the best practices and then having evidence based on this provided to the market so that the best practices are the ones that we keep pursuing or that we doubled down on from an investment standpoint.

And the worst practices are the ones that we weed out of the system.

Lisa Hamilton:
Sounds like you think it's also a research tool, now just an implementation tool.

Tristan Louis:
I do believe that very much that it's not just a research but an evidence tool that will then influence with policies should be, one of the things that's crazy to me is we spend about $24 billion a year on IT software and services to give us compliance data and not even compliance data that is consistent on a state by state basis.

The federal government is trying its best at getting all that compliance data and then hoping that from there, they can start guessing what some of the best practices are. But in the, in business world, those $24 billion are actually giving people real insights as to how to operate. Why can't we bring the kind of machine learning knowledge, the kind of heavy data crunching that exists in the private sector to the public sector and start looking at how we've been successfully historically. Because yes there are a lot of areas where we failed but there is also area where we've made tremendous progress and there are pockets all over the country of progress that has been made in certain population because not all treatments work the same for every population. But understanding, what are the factors that make a particular policy stick, will then allow us to create policies that are national level as well as an individualize state level that will work for the different population and help improve outcomes across the board.

Sixto Cancel:
One of the things I think of them is that, I think one of the things that has hindered the tech sector in social services, is the fact that we'd look to the for-profit sector for so much guidance. When the for-profit sector has been innovating on technology, their innovation continues to be the automation. First, we automated machines, to be able to replace them human with labor, then it became software and now we're looking at machine learning and AI and that extreme automation house for their end result, which is to go ahead and increase their bottom dollar.

And so, I think that, when we try to take things from that sector and just completely just apply a principle of digitizing and automating, that's where we get into trouble, because we did not go the same process at the for-profit sector went through which is, how do we go through our own design process to figure out what's our innovation in social services because our markers should be how do we help people heal? How do we help people develop abilities and then how do we position them to thrive? And then if we can use technology to go ahead and develop new tools that presents so much value that it makes the old thing obsolete.

When we look at Uber and we look at Airbnb, these companies a not going to ask permission and did not go research for permission from City Hall and so forth. They presented so much value in a new way of doing something that the tech actually disrupted the field, and what I believe that, we needed social services is not so much look at what's going on the for-profit sector, there are some learning lessons to have, yes. But to say how do we go through that same rigorous process and begin to create something that adds so much value, that it fundamentally changes the way that we work with children and families.

Tristan Louis:
I think we're in full agreement in terms of taking the rigorous process. The one thing that where I think we can leverage what is being done in the private sector, in that public sector, though, is the idea of taking large amounts of data because one of the things that we're actually, we can pretty good at is creating massive amounts of data. The problem is that that data is not available in the standard fashion and it's not really shared in a standard fashion across the board. So, it's pretty useless in terms of figuring out what that history looks like and that's history of involvement.

And when we do get to a point where we have normalized data, I agree with you that then we can start creating those revolutions. Because going with the intent, as you have, and as we have up saying, okay, we need to improve outcomes for technology is a start.

But then the question becomes, in the how. And the how is that we have to be very careful in terms of how to do it, because I don't want to necessarily impose my viewpoint as to what is the best approach until I have proof that that is actually working as a practice. And the reason I need that proof coming from the research is that if I am imposing practice and I happen to be wrong, I'm going to have a real negative impact on individuals’ lives.

However, if I'm basing that practice based on historical data, I can actually identify those pockets of practice that had been successful and can make sure that I have positive impact.

Lisa Hamilton:
Well, I want to jump in here and say, it sounds like you both have amazing ideas of what we can do to help spark greater technology innovation in the human services field, whether it's from leveraging data to improve practice or thinking about design from a more human-centered perspective, or using technology to automate and reduce some of the burden that our practitioners have. I think all of those are amazing suggestions for what the future of technology in human services ought to be.

With that, I think we're going to close our conversation. I want to thank both of you for joining us today. It's been great to hear both of your perspectives to learn about these incredibly innovative and helpful technology solutions that you are bringing to the field and more importantly to hear about the ways that they are improving and changing services for children and families, which is absolutely what we want to have happen.

I also want to thank our listeners for joining us as well.

If you've enjoyed today's conversation, please rate our show on Apple podcasts to help others find this. You can ask questions and leave us feedback on Twitter by using the KC cast hashtag. And to learn more about Casey and the work of our guests, you can find our show notes at aecf.org/podcast.

Until the next time, I wish all of America's kids and all of you a bright future.