Qualitative Study

Public health and social welfare fields increasingly recognize the need for preventative interventions that address root causes rather than respond to emergent problems – yet face significant challenges in designing tools and demonstrating success for such initiatives. We characterize these important, but difficult to develop and scale solutions using Dan Heath’s term “upstream work”. We then explore design solutions to support upstream work through a multi-phase co-design process to assist fire departments developing alternate EMS response programs to reduce 911 call volume.

This study investigates how disability providers engage in information provision within a fragmented disability service system. Through interviews with 61 providers from state, local, and nonprofit agencies from the state of Virginia, we identify two descriptive patterns of organizational information practices and five multi-level shaping factors: system disintegration, bureaucratic complexity, provider expertise, user technological readiness, and community trust.

Access to disability services information depends on many factors, from an individual’s digital literacy, social connections and physical mobility to the interface design of websites. However, it is also true that the availability of disability services information (e.g., how to apply for a Medicaid Waiver) and how such information is managed and provided to end users in Virginia are also critical factors that shape people’s information access. This assessment focuses on understanding the latter, namely, the “information ecology” of disability services in Virginia.

Public servants tasked with implementing rules or policies on the street-level often make discretionary decisions based on local context. Lipsky has labeled them street-level bureaucrats. During the COVID-19 pandemic, as most face-to-face interactions facilitated by local government moved online, many street-level decisions were moved to screens, representing the actions of who Bouvins and Zouridis refer to as screen-level bureaucrats. Discretionary decision-making among public servants continued, but much of it centered on the collection, analysis, and use of data.