I had the honor of sitting next to Dee Wilson when he delivered the Casey Family Assessment of Hennepin County’s Child welfare system to the Hennepin County Commissioners (Minnesota’s Child Endangerment Model).  Dee drew attention to damage being done by the toxic atmosphere in the Child & Family Services system, the inability of St Joseph’s home for children to manage the level of trauma their young clients were living with and pointed out the red herring that HIPPA laws have created by forbidding almost any public discussion of the conditions within the homes of abused children and the institutions of child protection.  I resonated with how social workers are traumatized by their work and how community based solutions involving stakeholders and redefining what we want for outcomes.

All a part of why turnover is high in social work and terrible policies doom children and families to more cyclical trauma and failure.within state child welfare systems.

When reading Dee’s recapping of County screened out rates remember that when 4 year old Eric Dean died after 15 reports of child abuse by mandated reporters, there were 4 MN counties that screened out 90% of all child abuse calls.

Dee keeps a blog and wrote something recently that every social worker needs to read.  He is the smartest person in the room on the topic.

All Adults Are the Protectors of All Children  (support KARA)

Workload Management in Child Protection Systems

 

In last month’s Sounding Board, I discussed several factors that have led to acute and chronic workload problems in public child welfare agencies: the steady growth in CPS reports from 1965 until the mid-1990’s, the doubling of the number of children in foster care from 1986-99 and the recent smaller increase in foster care since 2013.  In addition, relentlessly increasing policy and procedural frameworks have added to the time required to complete investigations and assessments, develop case plans, check on the health and safety of children in foster care, etc.  In other commentaries, I mentioned the reluctance of legislators and governors to continue to fund the growth of child welfare systems after multiple reform initiatives have, seemingly, failed to make significant improvements in child protection and foster care.  However, there is another factor that impacts the capacity of public child welfare agencies to cope with overwhelming workloads associated with inadequate staffing levels and high rates of turnover of recently hired staff: the lack of discretion to manage workload demands through prioritization, triage, reduction of investigative/assessment requirements and/or denial of services or reduced services to some groups of children and families.

 

Policymakers and (some) advocates in many states have followed a formula likely to create the same hopeless/helpless attitudes among child welfare staff characteristic of parents in chronic neglect cases: (a) underfund and inadequately staff child welfare systems, and (b) steadily add to the legal mandates that guide the work of these agencies while (c) denying to child welfare supervisors and managers the discretion to manage their workloads within the constraints imposed by resource and staffing deficits. It is not staffing shortages in and of themselves that lead to the demoralization of child welfare staff; rather, it is the lack of permission to cope with workload challenges that result from staffing shortages and other resource constraints in reasonable ways.

 

A Thought Experiment

 

Consider a medium sized child welfare office with two CPS units each of which have 6 caseworkers and a supervisor.  Assume that these two units are receiving an average of

230-240 CPS reports per month for investigation or assessment even though it’s widely understood that caseworkers can manage no more than 10-12 newly assigned investigations per month.  Will the children named as victims in these CPS reports be safer if all the reports are regularly assigned for investigation, or will child safety be served by limiting assignments to 12 new investigations per month, per caseworker, leaving 90 or more reports without CPS contact, or with nothing more than a second “screening” of phone contact with collateral sources to gather additional information regarding risk and safety issues?

Most policymakers and managers appear to believe that assigning all investigations, regardless of staffing levels, is the only responsible decision. If the assignment of new investigations has only recently occurred and is likely to be a temporary spike in assignments, they may be right. When assignments of new CPS investigations increase gradually, or occur suddenly, caseworkers and supervisors often perform heroically in the short run, working extra hours, foregoing breaks and lunch hours, depending on stimulants and adrenaline to work at a frenzied non-stop pace. However, within a few months, these extraordinary work habits will inevitably come to an end due to exhaustion, compromised health, family conflict and the realization that there is no end in sight to overwhelming workload demands.  Gradually at first, and then more rapidly, investigative/assessment standards will erode and, in some instances, collapse. Caseworkers may develop various shortcuts, for example, describing in a case record driving by a parent’s home whose car is not in the driveway as a home visit, or making non-emergent contacts with families without reviewing case records.  Phone calls and emails will often be responded to erratically.  Assessment tools are likely to be completed just prior to case closure.  Practice models may be given lip service but they will rarely guide caseworkers’ actions.  Superficial inadequate work will gradually become the norm, even on serious cases, unless supervisors are insistent that investigators meet a few minimum standards.

 

Unfortunately, the erosion of performance standards is likely to be the tip of the iceberg in chronically overwhelmed units. Some caseworkers will take increasing amounts of sick leave, and caseworkers who have been newly hired will begin to leave their jobs at high rates (30% plus) during the first 12-18 months of employment.  Experienced caseworkers with good reputations in the community will often find other employment. In extreme situations, there will begin to be turnover among supervisors. The reputation of CPS in the community will suffer as community professionals become intolerant of agency staff using workload problems as an all purpose excuse for inadequate performance.  Mandated reporters will come to view CPS programs as unreliable and perhaps wonder if making a CPS report will do more harm than good in most families.  Caseworkers and supervisors will often view child welfare managers unable or unwilling to do anything to control workloads as inept and ineffective. They will despair of policymakers and advocates who treat them with such disregard while attacking

the child welfare system for deficiencies created (mostly) by lack of adequate funding.

 

Overwhelming workload demands that continue for several months or years have devastating and potentially ruinous effects on child protection units and programs, effects that become more difficult to repair the longer they are left unchecked. The necessity to narrow the concerns of child protection will affect the conceptual understanding of child safety in ways that are highly questionable, and stifle the capacity to imagine how child protection systems can perform differently under better conditions. Even when staffing resources are greatly increased, thinking about child protection will continue to reflect the agency’s lengthy experience of chronic scarcity. The above example of CPS units receiving double the number of monthly assignments they can manage in accordance with agency policies is extreme, but by no means unusual. However, any ongoing level of assignment that leaves CPS caseworkers unable to consistently comply with agency policies and requirements will deprive caseworkers of the experience of a job well done. Shortcuts and compromises with best practices, as understood within the child welfare agency, will be commonplace. Caseworkers will likely have rational anxieties regarding what might happen to them if and when a child on their caseload is seriously injured or killed, given that their work on most cases is not fully in compliance with agency rules.

 

 Principles and Tools for Workload Management

 

In reflecting on workload management strategies, it is helpful to understand that, nationally, state child welfare systems screen out about 40% of CPS reports, usually because of the lack of allegations of child abuse and neglect as defined in law and agency policy.  States’ screen out rates vary from virtually zero to 70%.  Less than one in three screened in cases receive post-investigation/assessment services; 5-10% of alleged child victims are placed out of the home. The goal of workload management practices should be to identify the 25-30% of children in screened in cases who have the greatest need of child protection, and devote the lion’s share of caseworkers’ time to these children and their families. Legal mandates for CPS interventions should not cast a wide net unless policymakers are willing to adequately fund these mandates.

 

Some policymakers and child welfare managers may insist that legal or policy definitions of child abuse and neglect, screening practices, risk assessment at intake or following investigations, use of differential response systems (referred to as Family Assessment Response in Washington State), time limits on provision of voluntary services, etc., have nothing to do with workload management. I don’t question the sincerity of these views; however, the reality is that every facet of child protection affects

workload demands and has frequently been used to control workloads in child protection programs around the country. For example, some state statutes require CPS investigations of alleged educational neglect, or child witnessing of domestic violence. However, most state laws do not authorize CPS investigations of these conditions, in part because of the potentially huge impact on their child protection systems.

 

Consider Florida’s child welfare system which, in 2014, received more than 222,000 CPS reports with a screen out rate of 27%. If Florida’s screen out rate increased to 50% through changes in state law and agency policies, the number of CPS investigations in the state would decline by more than 50,000 per year, a 31% decline in investigations. From past contacts with child welfare managers in Florida, I understand that increasing the state’s screen out rate is a political non-starter despite decades of understaffed CPS programs. Nevertheless, Florida’s screening practices result in an annual CPS response rate of almost 71 per 1000 children in the state’s population, compared to an average of about 44 per 1000 nationally, a level of intervention Florida’s policymakers have never been willing to adequately support.

 

In Washington State, the situation is almost the reverse, i.e., the Children’s Administration (CA) screens out more than 60% of CPS reports. The state’s CPS response rate per 1000 in 2014 was 26.6. For more than two decades, CA intake units assigned risk tags from 1-5, i.e., low risk to high risk, to screened in CPS reports after screening out more than half of reports. One-fifth of screened in reports classified as low risk were referred to community agencies for follow up or sent a ‘low risk’ letter informing parents that a CPS report had been received but would not be investigated. Several years ago, CA stopped risk tagging intakes prior to investigation, apparently because top CA managers believed this practice endangered children. Screen out rates quickly increased to almost 60%, and currently exceed 60% of reports. Currently, CA achieves through its screening practices virtually the same workload controls the agency used to achieve through a combination of screening and risk tagging reports at intake. During the past few years, total CPS reports in Washington have increased by about a third, from 75,000 per year to almost 100,000 per year. During these same years, CA has received a small increase in casework positions, but nothing approaching the percentage increase in total CPS reports. CA has used one of the few tools it has to control workload, i.e., screening out of CPS reports,  during a period when policymakers were unwilling to give the agency large staff increases.

 

During recent years, I have been surprised to learn that some state child welfare systems use differential response (DR) systems to respond to workload pressures. In some states (I’m not referring to Washington), the time required to complete CPS investigations far exceeds the time needed to complete family assessments, in some states or counties by a factor of 2-1. In these child welfare systems, families receiving assessments rather than investigations may be no more likely to receive in-home services than investigated families. DR, in these circumstances, may not reflect an intent to serve moderate and low risk families in a less coercive way, but rather a means of quickly disposing of one-half to two-thirds of screened in reports with minimal effort.

 

It’s true that DR can be implemented in ways that endanger children, but are children safer in states that require CPS investigations of all screened in reports regardless of workload considerations? The answer is “no”, because in child welfare systems which are inadequately staffed, investigative practices will be shaped to an extreme degree by workload pressures. It will often make no difference whether a brief superficial contact with families is described as an assessment or an investigation.

 

Some states with huge backlogs of screened in CPS reports which have not been investigated or received a single home visit in weeks or months have developed expedited investigative procedures that allow a large percentage of these cases to be quickly closed. In this context, ‘expedited’ means abbreviated with multiple policy requirements waived. In extreme situations, CPS supervisors should be given the authority to waive some investigative requirements subject to managerial review, and with transparency to community professionals who have made the reports. Some state child welfare systems have given this authority to supervisors reluctant to use it due to fear of the repercussions if a child in an expedited investigation were to die in an abuse or neglect related incident.

 

Summary

 

Policymakers and/or public child welfare systems can use one or more of the following practices to control their CPS workloads:

 

  • In a state’s legal definitions of child abuse and neglect, and other state statutes, limit the scope of CPS intervention to a scale policymakers are willing to adequately support.
  • Screen out at least 50% of CPS reports at intake through screening criteria that set strict requirements for CPS investigations.
  • Divert one-fifth of screened in ‘low risk’ reports to community agencies for risk and safety screens and referrals to community services.
  • Give CPS supervisors the authority to waive some investigative or family assessment requirements during periods of heavy case assignment, subject to managerial review, for example the requirement in some states that all children in a family be interviewed during a CPS investigation even when not named as a victim in the CPS report.
  • Set a maximum number of investigations/assessments which can be assigned to a caseworker in a 90 day period of time; give child welfare managers the authority to hire retired staff or other community professionals, as needed, to carry out expedited procedures to maintain these workload standards and eliminate backlogs.

 

It is not in the interest of children who urgently need protection to ruin child protection programs by making impossible demands on caseworkers. Furthermore, severely limiting the power of supervisors and managers to control overwhelming workloads leads to a demoralized workforce. It also motivates CPS caseworkers and supervisors to find other jobs and undermines the reputation of entire child welfare systems and their managers.  Ignoring staffing limitations and other resource constraints in child welfare systems creates toxic organizational cultures. Only when policymakers and managers understand that effective child protection depends on the health, emotional well-being and commitment of an experienced strongly supported work force, will child protection reform initiatives begin to pay dividends.

 

The next Sounding Board will discuss workload management issues and strategies in foster care units.

 

 

 

Dee Wilson

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