Child Welfare
HHS Could Play a Greater Role in Helping Child Welfare Agencies Recruit and Retain Staff
Gao ID: GAO-03-357 March 31, 2003
A stable and highly skilled child welfare workforce is necessary to effectively provide child welfare services that meet federal goals. This report identifies (1) the challenges child welfare agencies face in recruiting and retaining child welfare workers and supervisors, (2) how recruitment and retention challenges have affected the safety and permanency outcomes of children in foster care, and (3) workforce practices that public and private child welfare agencies have implemented to successfully confront recruitment and retention challenges.
Child welfare agencies face a number of challenges in recruiting and retaining workers and supervisors. Low salaries, in particular, hinder agencies' ability to attract potential child welfare workers and to retain those already in the profession. Additionally, caseworkers GAO interviewed in all four of the states GAO visited cited high caseloads and related administrative burdens, which they said took from 50 to 80 percent of their time; a lack of supervisory support; and insufficient time to take training as issues impacting both their ability to work effectively and their decision to stay in the child welfare profession. Most of these issues also surfaced in GAO's analysis of 585 exit interviews completed by child welfare staff across the country who voluntarily severed their employment. According to caseworkers GAO interviewed, high turnover rates and staffing shortages leave remaining staff with insufficient time to establish relationships with children and families and make the necessary decisions to ensure safe and stable permanent placements. GAO's analysis of HHS's state child welfare agency reviews in 27 states corroborated caseworker accounts, showing that large caseloads and worker turnover delay the timeliness of investigations and limit the frequency of worker visits with children, hampering agencies' attainment of some key federal safety and permanency outcomes. Child welfare agencies have implemented various workforce practices to improve recruitment and retention--including engaging in university-agency training partnerships and obtaining agency accreditation, a goal achieved in part by reducing caseloads and enhancing supervision--but few of these initiatives have been rigorously evaluated.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
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GAO-03-357, Child Welfare: HHS Could Play a Greater Role in Helping Child Welfare Agencies Recruit and Retain Staff
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Welfare Agencies Recruit and Retain Staff' which was released on March
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Report to Congressional Requesters:
United States General Accounting Office:
GAO:
March 2003:
Child Welfare:
HHS Could Play a Greater Role in Helping Child Welfare Agencies Recruit
and Retain Staff:
GAO-03-357:
GAO Highlights:
Highlights of GAO-03-357, a report to Congressional Requesters
Why GAO Did This Study:
A stable and highly skilled child welfare workforce is necessary to
effectively provide child welfare services that meet federal goals.
This
report identifies (1) the challenges child welfare agencies face in
recruiting and retaining child welfare workers and supervisors, (2) how
recruitment and retention challenges have affected the safety and
permanency outcomes of children in foster care, and (3) workforce
practices that public and private child welfare agencies have
implemented
to successfully confront recruitment and retention challenges.
What GAO Found:
Child welfare agencies face a number of challenges in recruiting and
retaining workers and supervisors. Low salaries, in particular, hinder
agencies‘ ability to attract potential child welfare workers and to
retain
those already in the profession. Additionally, caseworkers GAO
interviewed
in all four of the states GAO visited cited high caseloads and related
administrative burdens, which they said took from 50 to 80 percent of
their time; a lack of supervisory support; and insufficient time to
take
training as issues impacting both their ability to work effectively and
their decision to stay in the child welfare profession. Most of these
issues also surfaced in GAO‘s analysis of 585 exit interviews completed
by
child welfare staff across the country who voluntarily severed their
employment.
According to caseworkers GAO interviewed, high turnover rates and
staffing
shortages leave remaining staff with insufficient time to establish
relationships with children and families and make the necessary
decisions
to ensure safe and stable permanent placements. GAO‘s analysis of HHS‘s
state child welfare agency reviews in 27 states corroborated caseworker
accounts, showing that large caseloads and worker turnover delay the
timeliness of investigations and limit the frequency of worker visits
with
children, hampering agencies‘ attainment of some key federal safety and
permanency outcomes.
Child welfare agencies have implemented various workforce practices to
improve recruitment and retention”including engaging in university-
agency
training partnerships and obtaining agency accreditation, a goal
achieved
in part by reducing caseloads and enhancing supervision”but few of
these
initiatives have been rigorously evaluated.
What GAO Recommends:
GAO recommends that the Secretary of Health and Human Services (HHS)
take
actions that may help child welfare agencies address the recruitment
and
retention challenges they face. Such efforts may include HHS (1) using
its
annual discretionary grant program to promote targeted research on the
effectiveness of perceived promising practices; and/or (2) issuing
guidance or providing technical assistance to encourage states to use
their program improvement plans to address the caseload, training, and
staffing issues cited in the reviews HHS conducts.
www.gao.gov/cgi-bin/getrpt?GAO-03-357
To view the full report click on the link above. For more information,
contact Cornelia Ashby at (202) 512-8403 or Ashbyc@GAO.gov.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Public and Private Child Welfare Agencies Face Challenges in Recruiting
and Retaining Workers and Supervisors:
Some Evidence Suggests How Recruitment and Retention Challenges Affect
Children‘s Safety and Permanency, but the Magnitude of the Effect Is
Unknown:
Agencies Have Implemented Various Workforce Practices, but Few Have
Been Fully Evaluated:
Conclusion:
Recommendation:
Agency Comments:
Appendix I: Scope and Methodology:
Appendix II: Selected Council on Accreditation for Children and Family
Services Standards:
Appendix III: Comments from the Department of Health and Human
Services:
Appendix IV: GAO Contacts and Acknowledgments:
GAO Contacts:
Acknowledgments:
Bibliography:
Related GAO Products:
Tables:
Table 1: CFSR Assessment Measures Whose Attainment was Affected by
Workforce Deficiencies in 5 or More of the
27 States Reviewed:
Table 2: BSW And MSW Programs Offered through Agency-University
Partnerships in Four States:
Table 3: Staff Qualifications:
Table 4: Supervisor Qualifications:
Table 5: Caseload Limitations:
Table 6: Supervisor-to-Staff Ratios:
Figures:
Figure 1: Distribution of Discretionary Grant Funds for Child Welfare
Services:
Figure 2: Major Channels of Federal Funding for Staff Development:
Figure 3: Comparison of Average and Individual Child Welfare Worker
Caseloads to Recommended Standards:
Abbreviations:
ACF: Administration for Children and Families:
AFSCME: American Federation of State, County, and Municipal
Employees:
APHSA: American Public Human Services Association:
ASFA: Adoption and Safe Families Act of 1997:
BSW: Bachelor‘s of Social Work:
CFSR: Child and Family Services Review:
COA: Council on Accreditation for Children and Family Services:
CWLA: Child Welfare League of America:
HHS: Health and Human Services:
MSW: Master‘s of Social Work:
PIP: program improvement plan:
TPR: termination of parental rights:
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United States General Accounting Office:
Washington, DC 20548:
March 31, 2003:
The Honorable Pete Stark
The Honorable James Greenwood
House of Representatives:
With more than 800,000 children estimated to spend some time in foster
care each year, the federal government allocates approximately $7
billion each year to states to investigate abuse and neglect, provide
placements to children outside their homes, and deliver services to
help keep families together. In addition to this funding, most of which
is used by states and counties to implement child welfare
programs,[Footnote 1] the Department of Health and Human Services (HHS)
monitors states‘ compliance with key federal goals, specified in part
by the Adoption and Safe Families Act (ASFA) of 1997, to keep children
safe and ensure their placement in stable and permanent homes. Through
its formal review process, known as the Child and Family Services
Review (CFSR), HHS uses specific assessment measures, such as agencies‘
ability to conduct timely abuse and neglect investigations and
regularly visit children in their homes, to assess the performance of
states‘ child welfare systems. HHS also provides guidance and technical
assistance through its 10 national resource centers and funds training
and research activities to improve child welfare services nationwide.
A stable and highly skilled child welfare workforce is necessary to
effectively provide child welfare services that meet federal goals.
Many child welfare caseworkers[Footnote 2] have professional degrees in
social work; however, this credential is not always required and many
practicing in child welfare have undergraduate degrees in seemingly
unrelated fields. Although the federal government has not set national
workforce standards, independent organizations such as the Child
Welfare League of America (CWLA) have developed guidelines concerning
staff qualifications and optimal caseload levels, which agencies may
voluntarily adopt. Agencies may also seek accreditation--a voluntary
review and 4-year certification process by the Council on Accreditation
for Children and Family Services (COA)--to help improve the delivery of
child welfare services.
You asked us to identify (1) the challenges these agencies face in
recruiting and retaining child welfare workers and supervisors, (2)
what is known about how recruitment and retention challenges have
affected children‘s safety and permanency outcomes, and (3) workforce
practices that public and private child welfare agencies have
implemented to confront these challenges.
To conduct our work, we obtained nearly 600 exit interview documents
completed by staff who severed their employment from 17 state,
40 county, and 19 private child welfare agencies and categorized the
reasons these former caseworkers provided for leaving their
jobs.[Footnote 3] Although the results of our exit interview analysis
are informative, we cannot generalize the results nationwide. We also
examined the available 27 Child and Family Services Reviews[Footnote 4]
and a variety of child welfare workforce studies to determine the
severity and scope of recruitment and retention challenges across the
country. To complement these analyses, we interviewed child welfare
experts and officials across the nation and conducted multiple site
visits to public and private child welfare agencies in four states--
California, Illinois, Kentucky, and Texas--to obtain first hand
information on workforce issues and their effect on children‘s safety
and permanency outcomes. We selected these states to represent a range
of urban and rural settings, county and state-administered systems, and
varying degrees of reliance on private child welfare agencies to
deliver services under contract. We also chose these states for the
variety of practices they have implemented to address their recruitment
and retention challenges. Furthermore, we contacted regional and
headquarters officials at HHS to identify and obtain any information
they had collected or disseminated on this topic and the impact of
federal funding to support child welfare staff development. We
conducted this work between March 2002 and January 2003 in accordance
with generally accepted government auditing standards. A more detailed
discussion of our scope and methodology appears in appendix I.
Results in Brief:
Public and private child welfare agencies face a number of challenges
recruiting and retaining workers and supervisors. Low salaries, in
particular, hinder agencies‘ ability to attract potential child welfare
workers and to retain those already in the field. For example,
caseworkers in each of the four states we visited said that many of
their former child welfare colleagues pursued positions in the
education field where they could not only make more money but also work
with children without risking their own safety. Disparities in the
salaries between public and private child welfare workers--with public
agency caseworkers generally earning higher salaries--also present a
retention challenge within the child welfare profession. Additionally,
high caseloads, administrative burdens, limited supervision, and
insufficient training reduce the appeal of child welfare work.
Caseworkers and supervisors in all four states cited demanding and
complex caseloads and related administrative requirements, such as
casework documentation, as factors affecting retention. Some of the
caseworkers we interviewed handle double the number of cases
recommended by advocacy organizations and spend between 50 and 80
percent of their time completing paperwork, thereby limiting their time
to assist children and families. Caseworkers told us that their desire
to stay in the child welfare profession was influenced by high-quality
supervision and adequate on-the-job training; however, these elements
were often lacking. Some newly promoted supervisors, in particular,
have said that they feel unprepared to meet job demands. Most of these
issues also surfaced in our review of exit interview documents,
although many workers indicated that they were leaving their positions
for reasons not directly related to the workplace, such as to retire,
stay at home with young children, or return to school.
Some evidence suggests how recruitment and retention challenges affect
children‘s safety and permanency. Caseworkers in the four states that
we visited said that high turnover rates and staffing shortages leave
remaining staff with insufficient time to conduct the types of home
visits necessary to assess children‘s safety and to make well-supported
decisions to ensure safe and stable permanent placements. Worker
turnover also disrupts the continuity of services, particularly when
newly assigned caseworkers have to conduct or reevaluate educational,
health, and safety assessments due to poor or insufficient information
in case files left behind by others. Our analysis of federal CFSRs
corroborated caseworker accounts, showing that large caseloads and
worker turnover delay the timeliness of investigations and limit the
frequency of worker visits with children, thereby hampering agencies‘
attainment of some key federal safety and permanency goals. HHS
officials said that they plan to examine these reviews to better
understand the relationship between recruitment and retention and
safety and permanency outcomes across the states. HHS currently has not
targeted retention and recruitment as priority issues, however, because
the federal government has no requirements concerning staffing and case
management, and states have made few requests of HHS‘s national
resource centers for assistance with child welfare staff recruitment
and retention.
Child welfare agencies have implemented various workforce practices--
including training partnerships, accreditation, and enhanced
supervision--to improve recruitment and retention, but few of these
initiatives have been fully evaluated. Dozens of state agencies have
used federal and state training dollars to form partnerships with
universities and their schools of social work to train current
caseworkers and better prepare social work students to enter the child
welfare profession. In exchange for tuition stipends, the students who
participate in these programs commit to work in a public child welfare
agency for a minimum specified term, typically 1 to 2 years. In
Kentucky and California, studies showed that 86 and
85 percent, respectively, of participants continued to work for the
agency after their minimum work commitment concluded. In Kentucky, this
retention rate far exceeded the percentage of nonparticipants who
remained with the agency over the same period. Accreditation can also
enhance recruitment and retention. Illinois officials told us that
meeting accreditation standards of lower caseloads, reduced supervisor-
to-staff ratios, and increased emphasis on professional credentials has
improved the agency‘s attractiveness to applicants and enhanced worker
morale and performance--two factors critical to retention.
Additionally, programs that improve supervision through leadership
development and specific mentoring relationships appear to aid in staff
decision making and reduce staff‘s case management related stress.
Other potentially promising practices include recruitment bonuses and
opportunities for applicants to preview jobs by viewing videotapes of
caseworkers performing their duties. In this way, caseworkers were
reported to have a clearer understanding of the job‘s requirements
before they accepted employment and appeared to be less intimidated by
the job‘s challenges once employed.
Given the reported impact of staffing shortages and high caseloads on
the attainment of federal outcome measures, we are recommending that
the Secretary of HHS take actions that may help child welfare agencies
address the recruitment and retention challenges they face. In
commenting on a draft of this report, the Administration for Children
and Families (ACF) generally agreed with our findings and
recommendation. ACF noted that it has begun to explore the
effectiveness of child welfare training programs, with an emphasis on
lessons learned and best practices. However, ACF also noted constraints
that it believes affect its ability to further assist the states. We
believe that ACF‘s stated actions represent a first step and, as we
recommended, that it should take additional actions to help child
welfare agencies address other facets of their recruitment and
retention challenges.
Background:
Most states and counties provide some child welfare services directly
and provide others through contracts with private agencies, where
caseworkers provide residential treatment and family support services
as well as reunification and adoption services. The role and level of
assistance that private child welfare agencies provide varies by state,
though in Illinois for example, approximately 80 percent of child
welfare services is reported to be provided through the private sector.
Although public and private child welfare agencies face different
financial constraints and use different personnel guidelines, national
survey data confirm that both state and private child welfare agencies
are experiencing similar challenges recruiting and retaining qualified
caseworkers. For instance, turnover of child welfare staff--which
affects both recruitment and retention efforts--has been estimated at
between
30 percent and 40 percent annually nationwide, with the average tenure
for child welfare workers being less than 2 years.
Evidence from a national child welfare workforce study indicates that
fewer than 15 percent of child welfare agencies require caseworkers to
hold either bachelors or masters degrees in social work,[Footnote 5]
despite several studies finding that Bachelor‘s of Social Work (BSW)
and Master‘s of Social Work (MSW) degrees correlate with higher job
performance and lower turnover rates among caseworkers.[Footnote 6]
Further evidence suggests that the majority of credentialed social
workers are not employed in child or family service professions;
instead, they choose professions in mental health, substance abuse
prevention, rehabilitation, and gerontology.
Nevertheless, child welfare caseworkers, assisted by their supervisors,
are at the core of the child welfare system, investigating reports of
abuse and neglect; coordinating substance abuse, mental health, or
supplemental services to keep families intact and prevent the need for
foster care; and arranging permanent or adoptive placements when
children must be removed from their homes. In some agencies,
caseworkers perform multiple functions from intake to placement on any
given case; in others, they are specialized in areas such as
investigations, reunification/family preservation, and adoptions. The
primary role of supervisors is to help caseworkers perform these
functions, thereby meeting the needs of families and carrying out the
agency‘s mission. Some functions of the child welfare supervisor
include assigning cases, monitoring caseworkers‘ progress in achieving
desired outcomes, providing feedback to caseworkers in order to help
develop their skills, supporting the emotional needs of caseworkers,
analyzing and addressing problems, and making decisions about cases. In
addition, given the challenges agencies face in recruiting and
retaining child welfare workers, some supervisors provide direct
assistance to caseworkers by taking on some of their cases.
The federal government‘s primary connection to the child welfare
workforce has been through its funding of child welfare training
programs as they relate to the provision of child welfare services. ACF
at HHS is responsible for the administration and oversight of the
approximately
$7 billion in federal funding allocated to states for child welfare
services. As part of this allocation, ACF provides matching funds for
the training and development of child welfare caseworkers through Title
IV-E of the Social Security Act. Title IV-E authorizes partial federal
reimbursement[Footnote 7]--75 percent--of states‘ training funds to
implement training programs for current child welfare staff and to
enhance the child welfare curriculum of undergraduate and graduate
social work programs to better educate and prepare potential
caseworkers. This funding may also be used for curriculum development,
materials and books, support for current workers to obtain a social
work degree, and incentives to induce entry to the child welfare field.
During fiscal year 2001, 49 states received
$276 million in Title IV-E training reimbursements.[Footnote 8] These
reimbursements ranged from a low of approximately $1,400 in Wyoming to
a high of more than $59 million in California, with the median
reimbursement approximating $3.1 million.
In addition, ACF‘s Children‘s Bureau manages six discretionary grant
programs through which it funds various activities related to
improvements in the child welfare system. Each of these programs
receives a separate annual appropriation from the Congress. One of
these programs--the Child Welfare Training Program, authorized by
Section 426 of Title IV of the Social Security Act--awards grants to
public and private nonprofit institutions of higher learning to develop
and improve the education, training, and resources available for child
welfare service providers. This is the only program of the six with a
specific emphasis on staff training;[Footnote 9] however, in fiscal
year 2002, it received the second smallest share--9 percent--of the
Children‘s Bureau‘s total discretionary funds (see fig. 1).
Figure 1: Distribution of Discretionary Grant Funds for Child Welfare
Services:
[See PDF for image]
[End of figure]
In 2000, ACF began a new federal review system to monitor states‘
compliance with federal child welfare laws. Under this system, ACF
conducts CFSRs, assessing states‘ performance in achieving the goals of
safety, permanency, and child and family well-being--three goals
emphasized in ASFA. The CFSR process involves a state self-assessment
and an on-site review by a joint team of federal and state officials to
assess states‘ performance on assessment measures such as timely
investigations of maltreatment and caseworker visits with
families.[Footnote 10] States that have not met the standards are
required to develop a program improvement plan (PIP) and can face the
withholding of federal funds should they fail to develop a plan or fail
to take the specified corrective actions. As of December 1, 2002, ACF
had completed and documented its reviews for
27 states.
In addition to these reviews, ACF provides assistance to states via its
10 resource centers, all of which have different areas of expertise,
such as organizational improvement, legal and judicial guidance, and
child welfare information technology. The primary goal of these centers
is to help states implement federal legislation intended to ensure the
safety, well-being, and permanency of children who enter the child
welfare system, to support statutorily mandated programs, and to
provide services to discretionary grant recipients. These centers
conduct needs assessments, sponsor national conference calls with
states, collaborate with other resource centers and agencies, and
provide on-site technical assistance and training to states. States may
request specific assistance from the centers; however, ACF sets the
centers‘ areas of focus and priorities, and no one center focuses
specifically on recruitment and retention issues at this time.
Figure 2 shows the major channels through which federal dollars can be
used for staff development.
Figure 2: Major Channels of Federal Funding for Staff Development:
[See PDF for image]
[End of figure]
Members of the current and previous Congress have introduced proposals
to expand federal funding to combat the recruitment and retention
challenges that child welfare agencies face. As of March 26, 2003, the
Congress was considering H.R. 14 and S. 342, each named the ’Keeping
Children and Families Safe Act of 2003,“ which contain provisions to
improve the training of supervisory and nonsupervisory workers; improve
public education relating to the role and responsibilities of the child
protective system; and provide procedures for improving the training,
retention, and supervision of caseworkers.[Footnote 11] The Congress is
also currently considering S. 409 and H.R. 734, bills that would
provide federal loan forgiveness to social workers who work for child
protective agencies and have obtained their bachelor‘s or master‘s
degrees in social work.[Footnote 12] As a tool to increase retention,
both of these bills tie education loan repayment to tenure, such that
the longer the caseworker remains with the agency, the greater the
share of the loan that is repaid. These bills would apply to
caseworkers in public and private child welfare agencies operating
under contract with the state.
Public and Private Child Welfare Agencies Face Challenges in Recruiting
and Retaining Workers and Supervisors:
Child welfare agencies face a number of challenges recruiting and
retaining workers and supervisors. Public and private agency officials
in all four of the states we visited struggled to provide salaries
competitive with those in comparable fields, such as teaching.
According to these officials, they lose both current workers and
potential hires to these fields, which pay higher wages and offer safer
and more predictable work environments. National salary data, though
somewhat broad in how it defines certain occupations, confirm that
child and family caseworkers earn less than educators. Specifically,
one county official in Texas said that teachers now earn starting
salaries of about $37,000 while entry-level caseworkers earn about
$28,000 annually, a difference of about 32 percent. Caseworkers we
interviewed in each state also cited administrative burdens, such as
increased paperwork requirements for each child in a case; a lack of
supervisory support; and insufficient time to participate in training
as issues impacting both their ability to work effectively and their
decision to stay in the child welfare profession. These issues were
mentioned by both public and private agency staff in all four states,
where some caseworkers handled double the number of cases recommended
by independent child welfare organizations. Former child welfare
workers also identified these issues in exit interview documents we
reviewed. In addition to retirement and other personal reasons staff
chose to leave their positions, low salaries and high caseloads were
among the factors affecting child welfare workers‘ decisions to sever
their employment.
Low Salaries Hinder Agencies‘ Ability to Maintain a Stable Workforce:
Public and private agencies we visited in all four states struggled to
provide salaries competitive with those in comparable occupations and
encountered difficulty retaining staff due to salary gaps within the
profession of child welfare. According to our analysis of 585 exit
interviews completed by staff who severed their employment, 81 cited
low pay as one of their reasons for leaving.[Footnote 13] In addition,
according to agency officials in all four states, they consistently
lose both current workers and potential hires to higher-paying
professions, such as teaching.[Footnote 14] The Bureau of Labor
Statistics‘ national wages survey[Footnote 15] reports that elementary
and middle school teachers earn, on average, about $42,000 annually
while social workers earn about $33,000.[Footnote 16] Furthermore, one
California private agency reported that foster care caseworkers with
MSWs who worked in group residential care facilities, which provide
structured living arrangements and treatment services for children with
complex needs, earned from $5,000 to $30,000 less than school
counselors, nurses, and medical and public health social
workers.[Footnote 17] Other states also report significant wage
disparities within the child welfare profession. One study in South
Carolina found that salaries for public agency caseworkers were almost
double those of direct care workers in private agency residential
programs.[Footnote 18] Additionally, according to labor union
representatives in Illinois, public agency caseworkers there earn
considerably more than staff in private child welfare agencies, and
union officials at the national level attribute this wage gap to their
lobbying efforts.
In addition, low salaries--because they often contribute to limited
applicant pools--can make it particularly difficult for agencies to
recruit child welfare staff in certain geographical areas and to serve
bilingual clients. For example, a New York State study of turnover
among caseworkers from January to December 2001 shows that small
counties near cities, in particular, have more difficulty recruiting
staff because of higher salaries in surrounding areas.[Footnote 19]
Additionally, in Texas for example, officials said that counties in
rural areas with larger Spanish-speaking and Native American
populations do not pay adequate salaries to successfully recruit
qualified bilingual staff or staff who are sensitive to local cultures.
State officials in Illinois and California echoed these concerns.
Furthermore, according to public agency caseworkers in Texas, their
salaries do not reflect the risks to personal safety they face as part
of their work. These caseworkers told us that given the safety risks
they are exposed to daily, they should be given hazardous duty pay
similar to workers in other high-risk professions. According to a
national study by the American Federation of State, County, and
Municipal Employees (AFSCME),[Footnote 20] a union representing
primarily government employees including child welfare caseworkers
throughout the country, caseworkers routinely deal with high levels of
risk. Specifically, AFSCME researchers found that more than 70 percent
of front-line caseworkers had been victims of violence or threats of
violence in the line of duty. In addition, in a peer exit interview
process conducted in one state we visited, 90 percent of its child
protective services employees reported that they had experienced verbal
threats; 30 percent experienced physical attacks; and 13 percent were
threatened with weapons.
High Caseloads, Administrative Burdens, Limited Supervision, and
Insufficient Training Reduce the Appeal of Child Welfare Work:
Although many of the caseworkers and supervisors we interviewed in each
state told us they were motivated by their desire to help people,
protect children, work with families, and potentially save lives, they
also told us that workplace issues such as high caseloads,
administrative burdens, limited supervision, and insufficient time to
participate in training reduce the appeal of child welfare work, making
it difficult for staff to stay in their positions. In each of the four
states we visited, the agency‘s inability to retain staff has
contributed to existing unmanageable caseloads. CWLA suggests a
caseload ratio of 12 to 15 children per caseworker, and COA suggests
that caseloads not exceed 18 children per caseworker. However, in its
May 2001 report, the American Public Human Services Association (APHSA)
reported that caseloads for individual child welfare workers ranged
from 10 to 110 children,[Footnote 21] with workers handling an average
of about 24 to 31 children each (see fig. 3). Managers we interviewed
in California confirmed this, stating that caseworkers often handle
double the recommended number of cases.
Figure 3: Comparison of Average and Individual Child Welfare Worker
Caseloads to Recommended Standards:
[See PDF for image]
Note: Cases are defined as one child. Not all open cases are actively
managed. According to a CWLA official, due in part to high caseloads,
case files that should be closed sometimes will remain open.
[End of figure]
Furthermore, caseworkers and supervisors we interviewed in the four
states we visited told us that heavy workloads encourage workers to
leave for other careers that they perceive as requiring less time and
energy. For instance, caseworkers in Texas told us that former co-
workers left the field to go into teaching, in part, because of the
more appealing work schedule, including seemingly shorter hours and
holidays and summers off. Also, caseworkers in all states we visited
emphasized concerns about the increasing complexity of cases--more
cases involve drug and alcohol abuse and special needs children, in
particular. In the exit interview documents we reviewed, 86 out of 585
child welfare workers identified high caseloads as a factor influencing
their decision to leave. One former private agency caseworker in
Delaware reported in an exit interview that, although caseloads were
manageable, the complexity of each case was a problem. In addition, one
former county worker in California said that cases are becoming
increasingly difficult, and caseworkers are no longer able to do
’social work.“ This caseworker also said that the amount of work and
stress is endless and limits the amount of time she has to perform her
job well.
Furthermore, caseworkers and supervisors in the four states we visited
told us that overwhelming administrative burdens, such as paperwork,
take up a large portion of their time, with some estimating between
50 percent and 80 percent. Some also said that these administrative
burdens were factors influencing their decisions to seek other types of
employment. According to two labor union representatives in
California,[Footnote 22] caseworkers often have to work overtime to
complete their paperwork, but instead of being compensated in salary
for their overtime, they are given days off. The representatives said,
however, that many caseworkers could not afford to take time off
because paperwork continues to mount in their absence. Caseworkers in
Illinois, for example, told us that they are required to complete more
than 150 forms per child in their caseload. Such requirements are
multiplied as caseloads increase. One study of the child welfare system
reported that part of the administrative burden child welfare workers
face also stems from the time they must spend in court as a result of
requirements of ASFA.[Footnote 23] The authors said that child welfare
workers frequently mentioned that the earlier and more frequent court
hearings that ASFA requires mean additional responsibilities for them.
Furthermore, in exit interview documentation we reviewed, workers
expressed frustration with these burdens, with some saying that they
spent insufficient amounts of time with families due to paperwork, in
particular, and that more clerical staff is needed to assist with
documentation. One caseworker in a California county indicated that
more than 80 percent of her job was administrative and that it was
impossible to meet all administrative requirements and do a quality job
at the same time.
Officials and caseworkers in all of the states we visited also
expressed concerns about the quality of supervision, with most
indicating that supervisory support either motivated caseworkers to
stay despite the stress and frustration of the job or that lack of
supervisory support was a critical factor in their decision to leave.
Although challenging, two critical functions of child welfare
supervisors are to recognize and respond to the needs and concerns of
caseworkers and to provide them with direction and guidance. However,
caseworkers we visited said that their supervisors are often too busy
to provide the level of supervision needed. In Kentucky, workers told
us that the inaccessibility of their supervisors negatively impacted
their effectiveness and morale. Furthermore, one Texas state official
told us that because of high turnover, caseworkers with only
3 years of experience are commonly promoted to supervisory positions.
According to tenured supervisors there, this advanced promotion track
has caused additional problems. Some newly promoted supervisors have
requested demotions because they feel unprepared for the job
requirements, and the caseworkers they supervise have complained of
poor management and insufficient support.
Our analysis of exit interview documents revealed that inadequate
supervision was not among the top five reasons caseworkers gave for
leaving, but some caseworkers (about 7 percent) cited it as an area of
concern. One former county caseworker in Pennsylvania, who had been
with the agency for 3 years, reported that her supervisor lacked both
leadership qualities and experience. Additionally, one private agency
caseworker in Wisconsin, who had left the agency after just 6 months,
reported in her exit interview that mentors were good when they were
available, but they were often unavailable due to work demands. She
also reported that mentorship becomes even more difficult when a group
of new caseworkers completes training at the same time, suggesting a
lack of tenured staff interested or available to provide such on-the-
job guidance. Furthermore, a former caseworker in Arizona reported that
communications with her supervisor were mainly through electronic mail-
-seldom in person. Finally, a former private agency caseworker in Maine
said that most interactions with her supervisor seemed punitive rather
than educational or supportive in nature.
Agency and supervisory support can mitigate the stress of the job and
the workload, according to some studies. For example, one California
county‘s workforce analysis stated that competent and supportive
supervision was critical to reducing staff turnover.[Footnote 24]
Another California study--in a county where most caseworkers indicated
that they were satisfied with their jobs--reported that these
caseworkers rated their relationship with supervisors as one of the
most satisfying factors of their work, giving supervisors very high
ratings for their effectiveness, personal skills, and ability to help
workers collaborate.[Footnote 25]
In addition to their concerns about supervision, caseworkers and
supervisors in all four states consistently told us that insufficient
training poses a recruitment and retention challenge to their agencies.
Specifically, they told us that training opportunities were often
inadequate to ensure a smooth transition for new recruits into the
agency. Despite the fact that public agencies in all four states had
both minimum requirements for training new hires and ongoing training
for senior workers, some caseworkers said that basic training does not
provide new staff with the skills they need to do their jobs.
Additionally, they told us that with high caseloads and work
priorities, neither supervisors nor tenured staff are able to conduct
on-the-job training to compensate. In one urban Texas region, for
example, caseworkers told us that new hires are typically assigned
between 40 and 60 cases within their first 3 months on the job.
According to caseworkers there, high caseloads and the limited time new
hires spend in training are often responsible for caseworker turnover.
Furthermore, by their supervisors‘ estimation, about half of new
trainees leave their jobs before completing 1 year. According to these
supervisors, many leave, in part, because they are not sufficiently
trained and supported to do their jobs.
Participation in ongoing training for staff at all levels also appears
problematic--caseworkers in each state told us either that available
training did not meet their needs or that they did not have time to
participate in classes. For example, in Illinois, caseworkers said
training was often too time-consuming and irrelevant. They added that,
given the administrative burdens of paperwork, they most need training
on paperwork management. Furthermore, university Title IV-E program
officials in Kentucky said that Title IV-E funds, which support
caseworker training and development, cannot be used to provide courses
specifically on substance abuse or mental health training,[Footnote 26]
which they noted would be particularly relevant to service delivery.
Additionally, caseworkers in all states we visited said that, when
training was available, high caseloads and work priorities hindered
their attendance. In Kentucky, for example, caseworkers told us that,
unless training is required, they do not attend because casework
accumulates, discounting the value of the training received. In
addition, caseworkers in California said that one program designed to
allow part-time work while they pursue an MSW is not practical because
caseloads are not reduced and performance expectations do not change.
Challenges in training child welfare workers also exist for public
agencies that contract with private agencies to provide services. The
federal government reimburses states 75 percent for training public
agency staff and 50 percent for training private agency employees. In
Illinois, where about 80 percent of child welfare services are provided
under contract with private agencies, training reimbursement has become
a major issue for workforce development. One program director said that
many workers have left private child welfare agencies in Illinois
because they did not believe that existing training programs adequately
prepared them to do their jobs. However, Illinois recently took steps
towards addressing these issues by pursuing a waiver from HHS to obtain
additional reimbursement for training expenses. According to HHS
officials, Illinois is the only state, to date, that has requested and
received this spending authority. From Illinois‘ officials‘
perspectives, however, states that have opted to privatize child
welfare services should not be penalized or compelled to apply for a
waiver in order to ensure that all service providers are adequately
trained.
Some Evidence Suggests How Recruitment and Retention Challenges Affect
Children‘s Safety and Permanency, but the Magnitude of the Effect Is
Unknown:
Caseworkers we interviewed in all four states and our analysis of HHS‘s
CFSRs indicate that recruitment and retention challenges affect
children‘s safety and permanency by producing staffing shortages that
increase the workloads of remaining staff. As a result, they have less
time to establish relationships with children and their families,
conduct frequent and meaningful home visits in order to assess
children‘s safety, and make thoughtful and well-supported decisions
regarding safe and stable permanent placements. Our analysis of the 27
available CFSRs corroborates caseworkers‘ experiences showing that
staff shortages, high caseloads, and worker turnover were factors
impeding progress toward the achievement of federal safety and
permanency outcomes. Although HHS officials told us that they plan to
examine these reviews to better understand the relationship between
recruitment and retention and safety and permanency outcomes across the
states, they have not yet completed this effort.
Agency Staff Shortages and High Caseloads Impair Caseworkers‘ Abilities
to Perform Critical Case Management Activities:
According to the caseworkers we interviewed in each of the four states,
staffing shortages and high caseloads disrupt case management by
limiting their ability to establish and maintain relationships with
children and families. They told us that gathering information to
develop and manage a child‘s case requires trust between the child and
the caseworker. Due to turnover, this trust is disrupted, making it
more difficult for caseworkers who assume these cases to elicit from
the child the type of information necessary to ensure appropriate care.
For example, when staff change, caseworkers may have to reestablish
information to update the case record, frustrating all parties
involved. Caseworkers noted that families become hesitant to work with
unfamiliar caseworkers, making it difficult to learn the history of the
case. The negative effects of turnover can be particularly pronounced
in group residential care facilities. According to several residential
care caseworkers in California and Illinois, worker turnover compounds
children‘s feelings of neglect and often results in behavior changes
that affect their therapeutic treatment plans. These workers said that
children channel their feelings of abandonment towards remaining staff,
become resistant to therapy, and act violently and aggressively towards
other children in the residential facility.
In every state we visited, caseworkers said that staffing shortages and
high caseloads have had detrimental effects on their abilities to make
well-supported and timely decisions regarding children‘s safety. Many
said that high caseloads require them to limit the number and quality
of the home visits they conduct, forcing them to focus only on the most
serious circumstances of abuse and neglect. One caseworker in Texas
noted that when she does make a home visit, the visit is quick and does
not enable her to identify subtle or potential risks to the child‘s
well-being.
Other caseworkers in all four states said that when they assume
responsibility for cases as a result of worker turnover, their own
caseloads increase and their ability to ensure the safety of the
children whose cases they assume is limited. For example, a Texas
caseworker told us that, when a former colleague left the agency, he
was assigned a case in which the initial investigation had not been
done. According to the caseworker, because his own caseload was high
before assuming responsibility for the new case, the investigation of
the abuse allegation and home visit were delayed by 3 months. As a
result of the delay, the claim could no longer be substantiated--the
evidence of alleged abuse had healed, no one could corroborate the
claim, and the case was closed. By his estimation, if the case
initially had been handled more quickly, or if high caseloads were not
driving attrition, caseworkers might be better able to identify,
mitigate, and/or prevent future situations that could possibly
jeopardize children‘s safety.
Additionally, all of the caseworkers we interviewed told us that
transitioning cases to remaining staff takes time and can result in
delays or changes to permanency decisions. Caseworkers in Kentucky
noted that this is particularly true when they assume responsibility
for a case with inadequate documentation. Given their high caseloads
and ASFA‘s requirements to file for termination of parental rights
(TPR) if the child has been in care 15 of the last 22 months,
caseworkers have little time to supplement a child‘s file with
additional investigations and site visits. As a result, they sometimes
make permanency decisions without thoroughly evaluating the adequacy
and appropriateness of available options. According to private agency
officials in Illinois, this type of unsupported decision making is
believed to result in placement disruptions, foster care re-entry, or
continued abuse and neglect. In addition, supervisors in Texas told us
that caseworkers often determine that filing a TPR under the 15-of 22-
month provision is not in the best interests of the child when
sufficient evidence is not available to support the TPR. In doing so,
the caseworkers are able to continue to conduct their
casework.[Footnote 27]
Child and Family Services Reviews Show That Workforce Deficiencies
Hamper Agencies‘ Attainment of Federal Child Welfare Outcomes:
Our examination of the 27 completed CFSRs corroborates caseworkers‘
statements about the impact of recruitment and retention challenges on
children‘s safety, permanency, and well-being. Although identifying
workforce deficiencies is not an objective of the CFSR process, in all
27 CFSRs we analyzed, HHS explicitly cited workforce deficiencies--high
caseloads, training deficiencies, and staffing shortages--that
affected the attainment of at least one assessment measure. While the
number of affected assessment measures varied by state, we found that
HHS cited these factors for an average of nine assessment measures per
state. Furthermore, more than half of the 27 states exceeded this
average. For example, Georgia‘s and Oregon‘s CFSRs showed the greatest
number of citations related to workforce deficiencies, with high
caseloads, training deficiencies, and staffing shortages affecting the
attainment of 14 and 16 assessment measures, respectively.
Additionally, several states‘ CFSRs present useful examples of how high
caseloads, limited training, and staffing shortages affect the outcomes
for children and families in care. For example, in Georgia, reviewers
found that case managers‘ caseloads were unreasonably high, limiting
their ability to conduct meaningful and frequent visits with families
and carry out their responsibilities. Additionally, in New Mexico‘s
CFSR, reviewers cited staff turnover and vacancies as affecting
workers‘ responsiveness to cases and decreasing their ability to help
children achieve permanency. Finally, the District of Columbia‘s CFSR
describes heavy workloads, high staff turnover, and a climate in which
supervisors often call new workers out of training to handle ongoing
caseload activities. Table 1 shows the assessment measures affected by
the workforce deficiencies in five or more states.
Table 1: CFSR Assessment Measures Whose Attainment was Affected by
Workforce Deficiencies in 5 or More of the 27 States Reviewed:
CFSR assessment measures: Caseworkers investigate reports of child
maltreatment in accordance with state policy.; States (total
number in parenthesis): AK, AZ, FL, GA, MA, NC, NM, OK, OR, TN, TX, VT,
WV, (13).
CFSR assessment measures: Caseworkers maintain diligent efforts to
provide services to families in order to protect children in home and
prevent removal.; States (total number in parenthesis): AK,
DE, KS, NC, NM, NY, OR, SD, TX, (9).
CFSR assessment measures: Caseworkers make diligent efforts to reduce
the risk of harm to children in each case.; States (total
number in parenthesis): AZ, NM, OR, TX, WV (5).
CFSR assessment measures: Caseworkers maintain stability of foster care
placement.; States (total number in parenthesis): CT, GA, NC,
NE, OK (5).
CFSR assessment measures: Caseworkers establish permanency goal for
child in timely manner.; States (total number in parenthesis):
AL, AZ, CT, DC, GA, IN, NC, NM, NY, OK, OR (11).
CFSR assessment measures: Caseworkers finalize adoptions with
appropriate and timely efforts; States (total number in
parenthesis): AK, AL, AZ, GA, ND, OR, TX, VT, WV (9).
CFSR assessment measures: Caseworkers assess and address the needs of
child, parents, and foster parents adequately.; States (total
number in parenthesis): AK, KS, ND, OR, PA, SD, WV (7).
CFSR assessment measures: Caseworkers involve children and families in
case planning.; States (total number in parenthesis): AK, AZ,
DE, FL, IN, KS, MN, NC (8).
CFSR assessment measures: Caseworkers adequately monitor child safety
and well-being through frequent visits with children, focusing on case
planning, service delivery, and goal attainment.; States
(total number in parenthesis): AK, DC, FL, GA, IN, NC, NM, OK, OR, TX,
VT, WV (12).
CFSR assessment measures: Caseworkers maintain sufficient face-to-face
contact with parents to promote attainment of case goals and ensure
children‘s safety and well-being.; States (total number in
parenthesis): DC, FL, GA, IN, NC, NE, OK, TX, VT (9).
CFSR assessment measures: Agency reduces incidence of repeat
maltreatment.; States (total number in parenthesis): IN, KS,
NM, NY, SD (5).
CFSR assessment measures: Agency provides a process that ensures that
each child has a written case plan to be developed jointly with the
child‘s parent(s) that includes the required provisions.;
States (total number in parenthesis): AK, AZ, CO, NE, OK, OR, TN, TX
(8).
CFSR assessment measures: Agency develops and implements standards to
ensure that children in foster care are provided quality services that
protect the safety and health of the children.; States (total
number in parenthesis): AK, CO, DC, KS, ND, VT (6).
CFSR assessment measures: Agency operates a staff development and
training program that supports the goals and objectives in the Child
and Family Services Plan[A] , addresses services provided under Titles
IV-B and IV-E, and provides initial training for all staff who deliver
these services.; States (total number in parenthesis): AK, AL,
AR, AZ, CO, CT, DC, DE, FL, GA, IN, KS, MA, MN, NC, ND, NE, NM, NY, OK,
OR, PA, SD, TN, TX VT, WV (27).
CFSR assessment measures: Agency provides ongoing training for staff
that addresses the skills and knowledge base needed to carry out their
duties with regard to the services included in the Child and Family
Service Plan.; States (total number in parenthesis): AK, AR,
AZ, CO, CT, DC, DE, FL, GA, IN, KS, MA, MN, NC, ND, NE, NM, NY, OK, OR,
PA, SD, TN, TX VT, WV (26).
Source: GAO‘s analysis of CFSR reports released before December 1,
2002.
Note: GAO defined workforce deficiencies as one or more of the
following: high caseloads, training deficiencies, and staffing
shortages.
[A] Child and Family Services Plans are required under Title IV-E of
the Social Security Act in order for states to receive federal foster
care funds for maintenance of foster children, specific administrative
costs associated with foster care programs, and adoption assistance.
[End of table]:
According to officials at HHS, few states have consulted the national
resource centers for recruitment-and retention-related guidance, and
HHS has not yet made these issues a priority in its technical
assistance efforts. Although one center is considering studying the
impact of recruitment and retention on federal safety outcomes, an
action plan is not yet in place. Additionally, although HHS officials
who participated in the CFSR process acknowledge that high caseloads
and worker turnover can pose barriers to conformity with federal
standards, HHS has not yet analyzed this relationship and does not
require states to use their PIPs to address existing recruitment and
retention challenges.[Footnote 28] While HHS has used CFSRs to identify
best practices concerning safety and permanency planning, officials
said the focus on states‘ workforce deficiencies and their impact on
safety and permanency outcomes has been limited. HHS attributed this
limited focus to the absence of federal standards regarding staffing
and case management.
Agencies Have Implemented Various Workforce Practices, but Few Have
Been Fully Evaluated:
Public and private agencies have implemented a variety of workforce
practices to address recruitment and retention challenges, but few of
these initiatives have been fully evaluated. University partnerships to
train current workers or prepare social work students for positions in
the child welfare profession are widespread, and two of the four states
we visited--Kentucky and California--have demonstrated several
benefits of these programs related to recruitment and retention.
Additionally, officials and caseworkers in Kentucky and Illinois told
us that COA‘s standards of lower caseloads, reduced supervisor-to-staff
ratios, and increased emphasis on professional credentials have
improved their attractiveness to applicants and enhanced worker morale
and performance--two factors they noted were critical to retention.
Furthermore, improvements to supervision, such as leadership
development or mentoring programs, may help alleviate worker stress
while other practices, such as the use of competency-based interviews
and realistic job previews, also appear to improve agencies‘ abilities
to hire staff who are better prepared for the job‘s requirements.
University-Agency Partnerships Appear to Improve Recruitment and Reduce
Turnover:
Available evidence suggests that more than 40 state agencies have
formed child welfare training partnerships--collaborations between
schools of social work and public child welfare agencies--to provide
stipends to participating students through use of federal Title IV-E
dollars and state contributions.[Footnote 29] These programs are
designed to prepare social work students for careers in the child
welfare profession and develop the skills of current workers. The
programs require that students receiving stipends for the study of
child welfare commit to employment with the state or county public
child welfare agency for a specified period of time. The length of the
contractual employment obligation--usually 1 to 2 years--and the
curriculum content each program offers differ by state and sometimes by
university.
While few in number, authors of available studies on the impact of
Title IV-E training partnerships suggest that they improve worker
retention. One study tracked four cohorts of students who participated
in a training partnership and found that overall, 93 percent continued
to be employed in the child welfare profession--and 52 percent remained
with public agencies--well beyond the minimum required by their
employment obligation.[Footnote 30] Furthermore, two of the states we
visited, Kentucky and California, conducted similar analyses of
employee graduates of Title IV-E programs, each finding that over 80
percent of participants remained with the state agencies after their
initial work obligations concluded (see table 2). Kentucky state
officials attribute these retention rates, in part, to the intensive
coursework, formal internships, and rigorous training included in the
curriculum of these training partnerships.
Table 2: BSW And MSW Programs Offered through Agency-University
Partnerships in Four States:
State program: California; Key features of partnership: [Empty]; Effect
on recruitment and retention: [Empty].
State program: California Social Work Education Center (CalSWEC) -
Collaboration between California‘s 15 graduate schools of social work,
its Department of Social Services, county welfare directors, and the
California chapter of the National Association of Social Workers.; Key
features of partnership: Objective is to recruit and prepare a diverse
group of social workers for careers in pubic service with special
emphasis on child welfare. In exchange for full financial aid, MSW
candidates enroll in child welfare classes, participate in fieldwork
placements, and agree to at least 1 year of full-time employment in a
county child welfare agency upon graduation.; Effect on recruitment and
retention: Based on data collected in 1999 from the cohort of all 1997
CalSWEC graduates, 85% remained with the agency after their contractual
employment obligation was completed.[A].
State program: Illinois; Key features of partnership: [Empty]; Effect
on recruitment and retention: [Empty].
State program: Passport Program - Collaboration between Illinois‘ 13
undergraduate schools of social work and the Department of Children and
Family Services.; Pena Professional Degree Program--Collaboration with
employee labor union and six graduate schools of social work to help
staff with a demonstrated commitment to child welfare and leadership in
the agency obtain their MSW.; Key features of partnership: Objective is
to improve recruitment, preparation, and retention of new hires.
Interested BSW candidates in their senior year receive full tuition in
exchange for committing 1 year of employment to the child welfare
agency upon graduation.; Illinois pays qualifying workers‘ tuitions and
provides paid time off to attend daytime classes. Participants sign a
payback agreement corresponding to the level of benefits they receive.
Selection is based on a review of a candidate‘s application and
concurrence with eligibility criteria. Receipt of the MSW is tied to an
automatic pay increase and promotion.; Effect on recruitment and
retention: The first cohort of Passport participants entered the
program in August 2001. The agency‘s goal is that 80% of participants
will be retained with the agency for at least 3 years. No formal
retention studies of either program have been conducted yet..
State program: Kentucky; Key features of partnership: [Empty]; Effect
on recruitment and retention: [Empty].
State program: Public Child Welfare Certification Program -
Collaboration between nine of Kentucky‘s undergraduate social work
schools and the Cabinet for Families and Children.; Key features of
partnership: Objective is to provide advanced knowledge and skill
preparation for undergraduate social work students entering the public
child welfare arena. In exchange for full financial aid during their
last 2 years in college, BSW candidates enroll in child welfare
classes, participate in fieldwork placements, and special retreats, and
agree to 2 years of full-time employment with the child welfare agency
upon graduation. The program uses common instructors, syllabi, and
texts.; Effect on recruitment and retention: A recent tracking study of
the first cohort of certification graduates found that 86% remained
with the agency beyond their contractual obligation,[B] while only 54%
of nonparticipants were retained..
State program: Texas; Key features of partnership: [Empty]; Effect on
recruitment and retention: [Empty].
State program: Throughout Texas, six universities offer both BSW and
MSW stipends; five offer BSW stipends only; and one offers only MSW
stipends. Title IV-E contracts are managed separately at the regional,
rather than state level.; Key features of partnership: BSW and MSW
students participate in field placements with the state‘s child welfare
agency and commit to a minimum of 1 year of full-time agency employment
upon graduation. Stipends also can be awarded to current staff--who
take courses part -time while working--for a maximum of 4 years.;
Effect on recruitment and retention: Graduates of one participating
Texas IV-E program were surveyed. 70% of respondents were still
employed with the agency after their contractual employment obligation
expired.[C].
Source: GAO‘s analysis.
[A] Dickinson, Nancy S., and Robin Perry. ’Do MSW Graduates Stay in
Public Child Welfare? Factors Influencing the Burnout and Retention
Rates of Specially Educated Child Welfare Workers.“ The California
Social Work Education Center. University of California at Berkeley,
August 1998. A new wave of the CalSWEC retention study began in August
2001 and data are still being analyzed.
[B] Barbee, A.P. ’Creating a Chain of Evidence for the Effectiveness of
Kentucky‘s Training System.“ For the CFSR. March 2003.
[C] Scannapieco, Maria and Kelli Connell-Carrick. ’Do Collaborations
with Schools of Social Work Make a Difference for the Field of Child
Welfare? Practice, Retention, and Curriculum.“ Journal of Human
Behavior in the Social Environment. 2003.
[End of table]:
Evaluations in Kentucky and California also suggest that training
partnerships improved worker competence. In both states, evaluations
found that staff hired through specially designed IV-E child welfare
programs performed better on the job and applied their training more
deftly than employees hired through other means. In their evaluation of
Kentucky‘s training partnership program, researchers tested all new
hires--those who had completed the program and those who did not--after
the agency‘s core competency training. Controlling for undergraduate
grade point averages, the study found that those who completed the
training scored better on the agency‘s test of core
competencies.[Footnote 31] Additionally, Kentucky supervisors, when
surveyed, reported that they considered certification students to be
better prepared for their job than other new employees. The California
study also compared training partnership participants with
nonparticipants and found similar results. Those who participated in
training partnerships scored higher on a test of child welfare
knowledge and reported greater competency in their work and a more
realistic view of child welfare work than those who had not
participated.[Footnote 32]
These studies and our discussion with caseworkers in all four states
suggest that while training partnerships may increase workers‘ skill
levels, caseworkers may still feel unprepared for the realities of
child welfare practice. The California study cited earlier found that
IV-E graduates did not have higher levels of job satisfaction or lower
levels of stress than their non-IV-E counterparts, and caseworkers who
graduated from the Kentucky certification program told us that even
with the training, they still felt unprepared to manage complex cases
and were constantly frustrated with the burdens of paperwork
documentation.
Systemic Improvements in Managing Child Welfare Cases Help Alleviate
Worker Stress:
Systemic improvements in managing child welfare, such as accreditation
and the enhancement of supervisor skills, help alleviate worker stress
by improving the working environment. According to state officials and
CWLA staff, accreditation facilitates high-quality service delivery, in
part, because it requires reasonable caseloads and reduces the number
of staff supervisors must oversee. Additionally, caseworkers and their
managers told us that supervisory training that focuses on leadership
skills and case management practices improves overall communication and
aids in staff decision making.
Accreditation:
Since 1977, the Council on Accreditation for Children and Family
Services has accredited public and private child welfare agencies that
comply with organizational, management, and service standards of child,
family, and behavioral healthcare services.[Footnote 33] Only two
states--Illinois and Kentucky--have fully accredited child welfare
systems,[Footnote 34] and caseworkers in Illinois and Kentucky told us
that adhering to these standards--in particular, those related to
caseloads and supervision--has improved their attractiveness to
applicants and enhanced worker morale and performance, two factors they
noted were critical to retention. COA‘s specific standards related to
maximum caseload size, supervisor-to-staff ratios, and professional
credentials for caseworkers and supervisors are shown in appendix II.
According to state officials in both Illinois and Kentucky,
accreditation has improved retention and helped their agencies better
focus on children‘s outcomes. Illinois‘ Department of Children and
Family Services received its accreditation in June 2000. Since that
time, all private agencies that contract with the state agency are
reported to have also received accreditation. According to the state‘s
child welfare director, the pursuit of accreditation stemmed from a
court order mandating smaller caseloads for staff and the fact that the
agency was confronting receivership and facing increased media
scrutiny.[Footnote 35] According to several Illinois supervisors,
accreditation changed the operations of the agency--they now operate
with reduced caseloads, improved internal communication, and increased
public confidence in the system. Furthermore, to prepare for
reaccreditation, staff engage in a routine practice called ’peer
review“ to determine how their caseload management contributes to the
state‘s safety and permanency outcomes measures. According to one
Illinois supervisor, preparing for these peer reviews has united staff
in a common goal and increased their attentiveness to service delivery.
Kentucky‘s Cabinet for Families and Children became accredited in
October 2002 and state officials there said that accreditation has
helped the agency professionalize child welfare staff by emphasizing
appropriate educational backgrounds, improving training, and building
pride within the organization. These officials also said that
accreditation has strengthened recruitment and improved retention
because the agency is focused on hiring qualified people who know what
to expect on the job. According to Kentucky supervisors and staff,
accreditation was also the driving force behind the creation of the
agency‘s new MSW stipend program, its push towards continuous service
quality improvement for children and families, and higher expectations
for staff performance.
To obtain these benefits, accreditation requires sustained financial
and organizational commitment. Even before applying, agencies devote
significant dollars to make their services and practices compliant with
COA eligibility standards. This process can entail reforming personnel
policies, hiring more staff, or upgrading communication and data
systems. Furthermore, the costs associated with 4-year accreditation
can range from $5,700 to more than $500,000, depending on an agency‘s
annual budget. Once accredited, filling vacancies to maintain rigorous
caseload standards, for example, becomes a constant and expensive
demand on agencies‘ resources. According to an HHS Inspector General
report on the topic,[Footnote 36] while many agencies that receive
accreditation may be performing well already, accreditation status does
not guarantee high-quality service.[Footnote 37] Caseworkers in
Illinois and Kentucky also mentioned this, telling us that they
continue to cut corners by limiting home visits or falling behind on
their documentation in order to manage both the volume and the
complexity of their caseloads. Furthermore, some agencies‘ staffing
shortages are so severe that implementing COA‘s educational
requirements might further restrict the pool of qualified applicants.
In some cases, personnel standards, such as minimum degree
requirements, may conflict with states‘ merit systems, particularly
those that govern personnel policies and procedures. Unlike Illinois
and Kentucky, which were able to revise their position classifications,
other states may not be able or interested in complying with this
standard. According to a state official in Texas, the state‘s child
welfare agency has no plans to pursue accreditation because caseloads-
-though recently reduced--are still well above COA‘s standard, and the
agency is currently struggling with staff turnover and high vacancy
rates.
Enhancements to Supervision and Mentoring:
States have taken a number of approaches to enhance staff supervision.
In Illinois, all supervisors are required to have an MSW, not only
because COA requires it, but also because state officials believe the
degree improves managers‘ competencies and knowledge. Kentucky is also
moving toward requiring MSWs of supervisors for the same reasons.
Currently, Kentucky prefers that caseworkers have a minimum of 5 years‘
experience before they can be promoted to supervisory positions.
Kentucky also has a supervisory development training series that
includes topics such as conflict resolution and supervisory skill
mastery. Similarly, Texas offers tenured managers courses in decision
making, program administration, and leadership. By late 2003, the
agency plans to have these managers serving as mentors and leadership
coaches for its new supervisors.
Kentucky has also taken steps to enhance the mentoring of new
caseworkers. A pilot program--designed for new hires that have not
participated in the undergraduate IV-E funded child welfare
certification program--affords new caseworkers, for their first 3
months on the job, the opportunity to observe and practice newly
acquired skills under the tutelage of tenured employees selected for
their superior performance in the agency. While an initial assessment
of the program indicated that employees‘ confidence in their skills
improved, additional improvements are underway and must be completed
before the program will be implemented across the state.
Use of Hiring Competencies, Realistic Job Previews and Recruitment
Bonuses May Enhance Agencies‘ Abilities to Hire Qualified Staff:
To avoid hiring decisions that may later result in turnover or poor
performance, some agencies have begun to develop hiring competencies,
use more realistic portrayals of an agency‘s mission, and offer
recruitment bonuses. While some evidence exists that these practices
improve recruitment and retention, few evaluations of their success
have been conducted.
Matching Recruits‘ Competencies and Expectations with Agency Needs:
Many states have created lists of desired worker competencies to
evaluate the skills of potential hires and match their expectations
with agency needs. The objective of these tools is to select candidates
who may be satisfied with and successful in the agency once
employed.[Footnote 38] Although Illinois requires certain academic
credentials of all new hires, the state also uses an applicant
screening tool to assess the education, writing ability, verbal
ability, cultural sensitivity, and ethics and judgment of candidates.
The screening requires candidates to complete several verbal or written
vignettes that represent realistic situations a child welfare
investigator or caseworker might encounter. Candidates are graded on
how they resolve situations as well as on technical skills, such as
writing and verbal ability. Additionally, recruiters in other states,
such as Colorado, Maine, Nebraska, and Wisconsin, require candidates to
demonstrate the required competencies in oral and written
communication, and explain how their interests, strengths, and academic
credentials or experiences fit with child welfare work. Furthermore,
Delaware‘s child welfare agency and one county in Texas are attempting
to maintain new hire pools--reserves of newly hired and trained
caseworkers--in order to fill vacancies quickly with competent and
well-prepared staff.
Agencies have also begun to use ’realistic job previews“--videos that
portray caseworkers confronting hostile families, working with the
courts, and learning agency practices and protocols. Nebraska‘s child
welfare agency developed a 25-minute realistic job preview video, which
is required viewing before any child welfare applicant can even
schedule an interview with agency officials. This video--similar to
ones that are used in some parts of Texas and California--describes the
requirements of maintaining accurate records and tracking children and
families‘ progress. The video also portrays the camaraderie caseworkers
and supervisors may share and documents the emotions caseworkers felt
when actions on their cases were either taken or delayed. Furthermore,
when piloting its use, researchers in Nebraska found that the realistic
job preview prompted ill-suited applicants to self-select out of job
competition, allowing the agency to focus its recruitment efforts on
the most eager and informed job candidates.
Using Bonuses to Attract and Retain Caseworkers:
Another recruitment and retention practice that appears to help child
welfare agencies hire competent staff has been the use of hiring or
signing bonuses. Although some child welfare agencies choose instead to
work towards more permanent increases in annual compensation packages,
child welfare officials in Riverside County, California, who have
implemented this practice perceive it as a necessary tool to fill their
growing number of vacancies. Furthermore, fields comparable to child
welfare, such as nursing--a profession in which an estimated
120,000 positions went unfilled last year--and teaching, have used
hiring bonuses in an attempt to reduce their labor shortages. Last
year, according to one study,[Footnote 39] 19 states and the District
of Columbia offered incentive programs, such as signing bonuses, to
relieve teaching shortages. In Riverside County, the social services
department began offering a hiring bonus in June 2000. New hires for
one difficult-to-fill caseworker position, which requires an MSW, are
currently offered $500 upon hiring, $500 after 6 months, and another
$1,000 after 1 year of service. An additional
$2,000 is granted annually to these hires until they reach their fifth
year of employment with the agency.
Little evidence exists across occupations to determine whether or not
incentive programs, such as bonuses, actually work to recruit and
retain employees. In Riverside County, human resource managers said
that they credit the monetary incentive with improving their ability to
hire more qualified workers, reduce turnover, and improve service to
clients. The county has not determined, however, what percentage of
those hired under the bonus plan have remained with the agency after 2
years on the job. Furthermore, Riverside has not done any studies to
isolate the impact of the bonus on employees‘ decisions to stay.
Conclusion:
Available evidence suggests that public and private child welfare
agencies are experiencing difficulty hiring, training, and retaining
their workforces. The absence of a stable, skilled, and attentive
workforce threatens these agencies‘ ability to provide services for the
more than 800,000 children estimated to spend some time in foster care
each year. For example, when staff shortages lead to additional
casework that delays decision-making, states have taken advantage of
the ASFA exemptions to the 15-of 22-month provision intended to move
children more quickly into permanent homes. While interviews with child
welfare workers in four states and our examination of CFSRs indicate
that workforce issues impair agencies‘ abilities to meet children‘s
needs, several workforce practices do appear to improve recruitment and
retention. HHS‘s role in identifying and addressing the challenges
agencies face, however, has been limited. For example, HHS has not yet
prioritized its research agenda to identify and/or assess promising
workforce practices. Additionally, it has not provided targeted
assistance to states to ensure that their PIPs adequately address the
caseload, training, and staffing issues cited in the CFSR process.
Engaging in such activities could enhance states‘ capacities to improve
their performance on safety and permanency assessment measures,
resulting in improved outcomes for children.
Recommendation:
Because of the reported impact staffing shortages and high caseloads
have on the attainment of federal outcome measures, we recommend that
the Secretary of HHS take actions that may help child welfare agencies
address the recruitment and retention challenges they face. Such
efforts may include HHS (1) using its annual discretionary grant
program to promote targeted research on the effectiveness of perceived
promising practices and/or (2) issuing guidance or providing technical
assistance to encourage states to use their program improvement plans
to address the caseload, training, and staffing issues cited in the
CFSR process.
Agency Comments:
We obtained comments on a draft of this report from HHS‘s
Administration for Children and Families. These comments are reproduced
in appendix III. ACF also provided technical clarifications, which we
incorporated when appropriate.
ACF generally agreed with our findings and said that our report
highlights many of the concerns that the department identified in its
analysis of the 32 Child and Family Services Reviews completed to date.
Specifically, ACF noted that a direct relationship was found between
the consistency and quality of caseworker visits with children and
families and the achievement of case outcomes evaluated in the reviews.
ACF also confirmed that high caseloads are a major factor in staff
turnover for those states in which a review was completed. ACF also
concurred with our recommendation, saying that it has begun to explore
the effectiveness of child welfare training programs, with an emphasis
on lessons learned and best practices. However, ACF stressed that it
has no authority to require states to address caseload issues in their
program improvement plans or to enforce any caseload standard. Further,
although ACF agreed that high caseloads also impact the ability of
child welfare agencies to help families achieve positive outcomes, it
said that the federal government has limited resources to assist states
in the area of staff recruitment and retention and noted that technical
assistance offered by the 10 resource centers is focused specifically
on those areas, such as permanency timeframes, where federal
legislative or regulatory requirements exist that states must achieve.
We believe that ACF‘s stated actions represent a first step and, as we
recommended, that it should take additional actions to help child
welfare agencies address other facets of their recruitment and
retention challenges.
We also provided a copy of our draft report to child welfare officials
in the four states we visited--California, Illinois, Kentucky, and
Texas. Each of these states generally agreed with our findings and
provided various technical comments, which we also incorporated when
appropriate.
We are sending copies of this report to the Secretary of Health and
Human Services, state child welfare directors, and other interested
parties. We will make copies available to others on request. If you or
your staff have any questions or wish to discuss this material further,
please call me at (202) 512-8403 or Diana Pietrowiak at (202) 512-6239.
Key contributors to this report are listed in appendix IV. This report
is available at no charge on GAO‘s Web site at http://www.gao.gov.
Cornelia M. Ashby, Director
Education, Workforce and Income Security Issues:
Signed by Cornelia M. Ashby:
[End of section]
Appendix I: Scope and Methodology:
In order to characterize the reasons for employee turnover, we engaged
in the first known national attempt to obtain and classify exit
interview documents from former child welfare caseworkers and
supervisors. To begin this analysis, we designed a survey to learn (1)
how many agencies were conducting and documenting exit interviews with
staff who severed their employment and (2) if these agencies would be
willing to share these documents with us. We distributed the survey to
the directors of all
40 state-administered child welfare agencies (including the District of
Columbia) and to a state-stratified sample of directors from 444 county
child welfare agencies[Footnote 40] in each of 10 county-administered
states.[Footnote 41] In addition, we sent our survey to a random sample
of 281 private child welfare agencies from a universe of 945 with Child
Welfare League of America (CWLA) membership. Responses to this survey
indicated that
18 states, 39 counties, and 51 private agencies were conducting,
documenting, and willing to share the exit interviews of staff who
severed their employment between January 1 and May 31, 2002.[Footnote
42] After follow up, we obtained and analyzed a total of 585 exit
interview documents from
17 states, 40 counties, and 19 private child welfare agencies across
the country.[Footnote 43] In addition, we received and reviewed summary
reports--in lieu of or to supplement actual exit interview documents--
from 5 states and
7 counties. Because of the low number of responses, we were unable to
generalize the results of our analysis beyond the data actually
received.
In addition to the exit interview analysis, we conducted interviews
with about 50 child welfare practitioners and researchers to determine
which states were experiencing recruitment and retention challenges and
how these were being addressed. We obtained and reviewed relevant
literature and selected four states in which to conduct comprehensive
site visits--California, Illinois, Kentucky, and Texas. We chose these
states in part due to their geographic diversity, the variation in
their caseload sizes, and their abilities to provide both urban and
rural perspectives on the issues. These states also varied in terms of
two important characteristics of child welfare programs--county versus
state administration and reliance on private agencies for the delivery
of services. In each state, we interviewed management, current
caseworkers, and supervisors at various private and public agencies;
obtained and reviewed relevant agency documents and data on vacancy,
turnover, salary, and caseload rates; and talked with appropriate child
welfare associations, advocacy groups, and researchers.
To determine the extent to which recruitment and retention challenges
affect children‘s safety, permanency, and well-being, we analyzed the
27 Child and Family Services Reviews (CFSRs) that the Department of
Health and Human Services (HHS) had completed and released to us by
December 1, 2002.[Footnote 44] Specifically, we conducted a content
analysis, noting each instance in which HHS explicitly cited high
caseloads, insufficient training, and staffing shortages as affecting
the attainment of all 45 CFSR assessment measures. In addition to the
CFSR analysis, we obtained evidence on the link between recruitment and
retention challenges and outcomes from conversations with caseworkers
and managers during our site visits and from available research on the
topic obtained through consultation with researchers and practitioners.
To determine the workforce practices public and private agencies have
implemented to confront recruitment and retention challenges, we relied
on site visits to the four states, interviews with experts and
researchers, and relevant studies that highlighted those strategies
with promise. We were not able to conclusively determine whether such
strategies were or will be successful, because most agencies did not
conduct research that could isolate the effect of the practices we
investigated.
We conducted our work between March 2002 and January 2003 in accordance
with generally accepted government auditing standards.
[End of section]
Appendix II: Selected Council on Accreditation for Children and Family
Services Standards:
Table 3: Staff Qualifications:
Service area: Child Protective Services; Standard: At a minimum,
personnel assigned to the child protective service have (a) a master‘s
degree in social work or a comparable human service field from an
accredited institution and 2 years of direct practice experience or (b)
a bachelor‘s degree in social work or a comparable human service field
and supervision by a person with a master‘s degree in social work or a
comparable human service field who has 2 years of experience in the
delivery of child protective services..
Service area: Adoption Services; Standard: Direct service personnel are
qualified according to the following criteria:; (a) previous experience
in providing adoption services or family and children services, (b) a
bachelor‘s degree from an accredited program of social work education,
or (c) a bachelor‘s degree in another human service field. COA
Interpretation (S14.10.02):; Recently hired direct service providers
who do not have prior experience in adoption receive 10 or more hours
of in-service adoption training per year..
Service area: Foster and Kinship Care Services; Standard: Family foster
care and kinship care workers have (a) an advanced degree from an
accredited program of social work education or a comparable human
service field or (b) a bachelor‘s degree in social work or a related
human service field, with supervision by a person with an advanced
degree in social work or a comparable human service field who has at
least 2 years‘ experience in services to families and children.; The
kinship care service is staffed according to the following: (a) kinship
care workers have a bachelor‘s in social work or another related human
service field and (b) supervisors possess an advanced degree from an
accredited program of social work education or another comparable human
service field and have experience working with families and children..
Service area: Residential Treatment; Standard: Residential counselors
and/or child care workers have (a) a bachelor‘s degree (If a few
extensively experienced and highly trained persons lack a bachelor‘s
degree and/or are in the process of obtaining the degree, their
training and experience is thoroughly documented.); (b) the personal
characteristics and experience to provide appropriate care to
residents, win their respect, guide them in their development, manage a
home effectively, and participate in the overall treatment program; (c)
the temperament to work with and care for children, youth, or adults
with special needs, as appropriate; and (d) basic skills in first-aid
and the identification of medical needs..
Service area: Family-Centered Casework: Intensive Family Preservation;
Standard: Direct service providers/practitioners are qualified by (a)
an advanced degree in social work or a comparable human service field
from an accredited institution and at least 2 years‘ experience in
family and children‘s services and/or (b) a bachelor‘s degree in social
work or another human service field from an accredited institution and
at least 3 years‘ post-degree experience in family and children‘s
services. COA Interpretation (S20.7.02):; It is common for an
interdisciplinary team to work collaboratively with families. This team
may be comprised of individuals from the following fields: social work,
mental health, special education, health (including nursing and public
health), and juvenile justice. Examples of acceptable exceptions, if
they represent a small percentage of the whole, include a BSW with only
2 years of post-degree experience or an MSW with experience in another
area of practice not directly applicable to family centered services..
Source: Council on Accreditation Standards and Self Study Manual, 7th
Edition, 2001.
[End of table]
Table 4: Supervisor Qualifications:
Service area: Child Protective Services; Standard: Supervisors hold an
advanced degree from an accredited social work program or a comparable
human service field and have had at least
2 years of direct practice experience in services to families and
children..
Service area: Adoption Services; Standard: Supervisory personnel have
prior professional experience in providing family and children‘s
services and have an advanced degree from an accredited program of
social work education or an accredited program in another human service
field..
Service area: Foster and Kinship Care Services; Standard: Foster/
kinship care supervisors possess an advanced degree from an accredited
program of social work education or a comparable human service field
and 2 years of direct practice experience..
Service area: Family Centered Casework: Intensive Family Preservation;
Standard: Supervisors have at least an advanced degree in social work
or in a comparable human service field from an accredited institution
and
2 years‘ post-master‘s degree experience in the delivery of family and
children‘s services..
Source: Council on Accreditation Standards and Self Study Manual, 7th
Edition, 2001.
[End of table]
Table 5: Caseload Limitations:
Service area: Child Protective Services; Standard: Under no
circumstances does a child protective worker‘s caseload exceed (a) 15
cases at one time that involve intensive intervention or investigation;
(b) 30 cases at one time that involve case coordination, continuing
services, or follow-up; and/or (c) a proportionate mix of the above.
COA Interpretation (S10.7.07):; A child protective service case is
defined as a child, unless a family assessment model or equivalent is
used. In this situation, the organization must provide average caseload
sizes under categories (a) and (b) and a rationale..
Service area: Adoption Services; Standard: The organization structures
its services so that adoption caseloads (a) do not exceed
25 families per worker when counseling birth families, preparing and
assessing adoptive applicants for infant placements, and supporting
these families following placement; (b) do not exceed 12 children per
worker when preparing children for adoption who are older or who have
special needs; (c) do not exceed 15 families per worker when preparing
and assessing adoptive applicants for the placement of children who are
older or have special needs and providing support to these families
following placement; and (d) are adjusted for case complexity, travel,
and nondirect service time..
Service area: Foster and Kinship Care Services; Standard: Caseloads for
family foster and kinship workers do not exceed 18 children, and
workers are able to perform their functions within these guidelines.;
Treatment foster care workers have caseloads of no more than 8
treatment foster care children.; Kinship care caseload sizes do not
exceed 12-15 families per worker. COA note: Reviewers may vary caseload
limits set by rating indicators if the organization can demonstrate
that (1) its workers do not have responsibility for a major, routine
component of case work (i.e., planning); and (2) a time study has been
done to adequately justify the organization‘s caseload limits..
Service area: Residential Treatment; Standard: Caseloads for direct
care personnel do not exceed 12 residents..
Service area: Family Centered Casework: Intensive Family Preservation;
Standard: For family-centered casework programs, caseloads are
generally limited to 12 or fewer cases per direct service provider and
are adjusted downward according to (a) internal organizational
procedures governing caseload size that address the relationship
between target population needs, duration and intensity of service, the
number of service hours needed based on the issues presented, and the
personnel model chosen by the organization; (b). the size of teams, if
the service is team-delivered; (c) the need for extra attention in
high-risk families; and (d) the need for balance between families at
beginning stages of work, families moving toward termination, and
families presenting different levels of need.; For intensive family
preservation programs, the organization limits caseloads to
approximately 2 to 6 families per direct service provider or team and,
within that range, caseloads are adjusted according to (a) internal
organization procedures governing caseload size that address the
relationship between target population needs, duration and intensity of
service, the number of service hours needed based on the issues
presented and the personnel model chosen by the organization; (b) the
need for extra attention in cases where there is active suicidal,
homicidal or assault behavior, failure-to-thrive or severe neglect, or
increased degree of risk of harm to children, families, or the
community; and (c) the need for balance between families at the
beginning stages of work, families moving toward termination, and
families presenting different levels of need..
Source: Council on Accreditation Standards and Self Study Manual, 7th
Edition, 2001.
[End of table]
Table 6: Supervisor-to-Staff Ratios:
Service area: Child Protective Services; Standard: A child protective
service supervisor is responsible for supervising no more than (a)
seven workers who are experienced and professionally trained and/or (b)
five workers who have less professional education and experience..
Service area: Foster and Kinship Care Services; Standard: The maximum
supervisor to caseworker ratio is 1:5..
Service area: Family Centered Casework: Intensive Family Preservation;
Standard: The standards for supervisory workloads are: (a) one full-
time equivalent supervisor for each of five to eight practitioners or
teams and (b) appropriately modified for total number of families
represented, experience levels of practitioners, geographic distances,
size of teams, and other relevant factors..
Source: Council on Accreditation Standards and Self Study Manual, 7th
Edition, 2001.
[End of table]
[End of section]
Appendix III: Comments from the Department of Health and Human
Services:
DEPARTMENT OF HEALTH AND HUMAN SERVICES:
ADMINISTRATION FOR CHILDREN AND FAMILIES
Office of the Assistant Secretary,
Suite 600 370 L‘Enfant Promenade, S.W.
Washington, D.C. 20447:
MAR 18 2003:
TO: Cornelia M. Ashby:
Director, Education, Workforce, and Income Security Issues General
Accounting Office:
FROM: Wade F. Horn, Ph.D. Assistant Secretary:
for Children and Families:
SUBJECT: Comments on the GAO Draft Report, ’HHS Could Play a Greater
Role in Helping Child Welfare Agencies Recruit and Retain Staff,“ GAO-
03-357:
Attached are the Administration for Children and Families‘ comments on
the GAO Draft Report, ’HHS Could Play a Greater Role in Helping Child
Welfare Agencies Recruit and Retain Staff, ’ GAO-03-357.
Should you have questions regarding our comments, please contact Marva
Benjamin, Child Welfare Program Specialist, Administration on Children,
Youth and Families, at (202)205-8405.
Attachment:
COMMENTS OF THE ADMINSTRATION FOR CHILDREN AND FAMILIES ON THE GENERAL
ACCOUNTING OFFICE‘S DRAFT REPORT, ’HHS COULD PLAY A GREATER ROLE IN
HELPING CHILD WELFARE AGENCIES RECRUIT AND RETAIN STAFF“ (GAO-03-357):
The Administration for Children and Families (ACF), Administration on
Children, Youth and Families (ACYF), Children‘s Bureau (CB) appreciates
the opportunity to comment on this draft report, which addresses the
causes, impact of, and possible solutions to staff recruitment
challenges and turnover rates in child welfare programs.
General Comments:
This report provides a thoughtful analysis of data about and interviews
with child welfare staff at the local and State office levels. States
may use this information to help prioritize their efforts to develop
and maintain an effective child welfare workforce. Further, although
few in number, the ACF funded university and State child welfare agency
partnerships referenced in this report have had a positive impact on
State child welfare agencies‘ ability to recruit and retain child
welfare staff. Since States face many different caseworker recruitment
and retention barriers, State-specific assessments are a useful way for
them to understand current personnel practices, training programs and
supervision in order to develop effective strategies for improvement.
Such strategies must take into consideration the requirements of the
Adoption and Safe Families Act (ASFA) of 1997. The principles that
govern this Act to ensure child safety and shorten the time frame for
making permanency decisions are the safety, permanency and well-being
of children and their families. The Department of Health and Human
Services (HHS) monitors State compliance with ASFA through the Child
and Family Services Reviews (CFSRs).
ACF‘s initial analysis of the CFSR data involving the first 32 States
reviewed makes it abundantly clear that sufficient staff to make
regular, substantive contacts with the children and families in their
caseloads is essential. A direct relationship was found between the
consistency and quality of caseworker visits with the child and family
and the achievement of case outcomes evaluated in the CFSR. Although
such a correlation has long been suspected, this is the first time that
data provided a basis for ACF to note with confidence that consistency
in caseworker visitation has a positive impact on achieving the Federal
expectations set for State child welfare program performance.
Additionally, analysis of the data related to State performance in the
CFSR found that none of the first 32 States reviewed were in
substantial conformity with the well-being outcome that ’Families have
enhanced capacity to provide for their children‘s needs.“ This is
consistent with the GAO report finding that caseworkers interviewed
cited staffing shortages and high caseloads as factors that disrupt
their ability to establish and maintain relationships with children and
families. Other major factors cited are the overwhelming administrative
burdens of paperwork requirements, and at least one study attributed
part of the administrative burdens caseworkers face to the time they
must spend in court as a result of ASFA requirements. However, it is
unclear as to the extent paperwork requirements involving documentation
of case planning with families affects efforts to prevent removals and
achieve permanency consistent with ASFA requirements. Nevertheless, as
noted in the GAO report, these barriers to relationship building:
hamper gathering information from each family to identify service
needs. Logically, if service needs are not adequately identified, the
family‘s capacity to better provide for their children‘s needs cannot
be substantially improved.
GAO Recommendation:
Because of the reported impact of staffing shortages and high caseloads
on the attainment of Federal outcome measures, GAO recommends that the
Secretary of HHS take actions that may help child welfare agencies
address the recruitment and retention challenges they face. Such
efforts may include HHS (1) using its annual discretionary grant
program to promote targeted research on the effectiveness of perceived
promising practices and/or (2) issuing guidance or providing technical
assistance to States to ensure that States‘ program improvement plans
adequately address the caseload, training and staffing issues cited in
the reviews HHS conducts.
ACF Comments:
ACF concurs with GAO‘s recommendation on the need for action in
addressing staff recruitment and retention issues. Activities have been
set in motion to explore the effectiveness of child welfare training
programs, with an emphasis on lessons learned and best practices. ACF
believes that there is a need to develop and implement a training model
on recruiting and retaining a strong workforce in child welfare. A
strong workforce includes professionally trained, front-line workers
with desired worker competencies, as well as placing a strong emphasis
on learning, innovation and staff development. With regard to the
recommendation to issue guidance or provide technical assistance to
States for ensuring that their program improvement plans (PIPs) address
caseload, training and staffing issues, it must be stressed that HHS
has no authority to require States to address caseload issues in their
PIPS nor does it have authority to enforce any such caseload provision.
The Child and Family Services (CFS) reviews provide an outcomes-based
model utilizing multiple sources of information for assessing child
protection and child welfare services provided by the States. As part
of the CFS review, States are required to conduct a Statewide self-
assessment to identify program strengths and barriers to performance in
relation to Federal requirements. The systemic indicator which HHS
monitors related to casework staff is based on Federal law and is as
follows:
’The State is operating a staff development and training program that
supports the goals and objectives in the Child and Family Service Plan
(CFSP), addresses services provided under titles IV-B and IV-E, and
provides initial training for all staff who deliver these services.“:
Although the CFS review does not include issues such as caseload size
in its review process, it is nevertheless clear from interviewing staff
in the 32 States that have undergone the CFS review that high caseloads
are a major contributor to staff turnover. Such high caseloads also
impact the ability of child welfare agencies to help families achieve
positive outcomes.
Issues related to caseworker training and performance are noted in the
CFS review during the on-site review of specific cases and in local and
State-level stakeholder interviews. The additional information
obtained during the CFS review gives the context needed to understand
how staffing patterns, high caseload and worker retention impact case
outcomes. Using the full information gathered in the review allows HHS
to target technical assistance resources better to specific barriers in
each State.
A number of States have identified strategies that target workforce
stabilization and reduction in caseloads as part of their PIP in order
to improve outcomes for children and families, e.g., the District of
Columbia and Georgia. Yet, the Federal government has limited resources
to offer States in these efforts and the training and technical
assistance offered by the ten resource centers funded by the Children‘s
Bureau are focused specifically on those areas where there are Federal
legislative or regulatory requirements that the States must achieve.
Each State will have completed a Statewide assessment by October 2004.
The CFS reviews help identify strengths the States have to build on and
the needs they should address in program improvement plans.
[End of section]
Appendix IV: GAO Contacts and Acknowledgments:
GAO Contacts:
Diana Pietrowiak, (202) 512-6239
Joy Gambino, (202) 512-2838:
Acknowledgments:
In addition to those named above, Gwendolyn Adelekun, Nancy Cosentino,
and Nila Garces made key contributions to this report. Barbara Alsip,
Avrum Ashery, Patrick DiBattista, Catherine Hurley, and Luann Moy also
provided key technical assistance.
[End of section]
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Alwon, Floyd J. and Andrew L. Reitz. ’Empty Chairs.“ Children‘s Voice.
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American Federation of State, County, Municipal Employees. Double
Jeopardy: Caseworkers at Risk Helping At-Risk Kids: A Report on the
Working Conditions Facing Child Welfare Workers, 1998.
Barbee, A.P. ’Creating a Chain of Evidence for the Effectiveness of
Kentucky‘s Training System.“ For CFSR. March 2003.
Barbee, A.P., et al. ’The Importance of Training Reinforcement in Child
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Barth, Michael C. and Yvon Pho. ’The Labor Market for Social Workers: A
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Bernotavicz, Freda and Amy Locke Wischmann. ’Hiring Child Welfare
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Management. International Personnel Management Association. Spring
2000.
California Alliance of Child and Family Services. Comparison of Foster
Care Funding for the Wages of Child Care Workers and Social Workers in
Group Homes with Wages in Other Occupations. July 1, 2001.
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Annotated Bibliography - Child Welfare Workforce. June 2002.
Child Welfare League of America. Standards of Excellence for Family
Foster Care Services. 1995.
Child Welfare League of America. Standards of Excellence for Kinship
Care Services, 2000.
Child Welfare League of America ’Minimum Education Required by State
Child Welfare Agencies, Percent, By Degree Type, 1998.“ State Child
Welfare Agency Survey. 1999:
Cicero-Reese, Bessie and Phyllis N. Clark. ’Research Findings Suggest
Why Child Welfare Workers Stay on Job.“ Partnerships for Child Welfare
News Letter. Vol. 5 No. 5. February 1998.
Council on Accreditation Standards and Self-Study Manual. 7th Edition,
2001.
Cyphers, Gary. Report from the Child Welfare Workforce Survey: State
and County Data and Findings. American Public Human Services
Association. May 2001.
Dhooper, S.S., D.D Royse, and L.C. Wolfe. ’Does Social Work Education
Make a Difference?“ Social Work, Vol. 35. No. 1. 1990.
Dickinson, Nancy S., and Robin Perry. Do MSW Graduates Stay in Public
Child Welfare? Factors Influencing the Burnout and Retention Rates of
Specially Educated Child Welfare Workers. The California Social Work
Education Center. University of California at Berkeley, August 1998.
Doelling, Carol Nesslein, and Barbara Matz. Social Work Career
Development Group. Job Market Report on 2000 MSW Graduates. George
Warren Brown School of Social Work. Washington University, St. Louis,
MO. N.p., n.d.
Doelling, Carol Nesslein, and Karen Joseph Robards. Excerpts from 1996-
2000 Alumni Survey Self-Study Report. George Warren Brown School of
Social Work. Washington University in St. Louis, St. Louis, MO. August
2001.
Fox, S., D. Burnham, A.P. Barbee, and P. Yankeelov. ’Public School to
Work: Social Work that is! Maximizing Agency/University Partnerships in
Preparing Child Welfare Workers.“ Training and Development in Human
Services, I. 2000:
Fox, S., V. Miller, and A. P. Barbee. ’Finding and Keeping Child
Welfare Workers: Effective Use of Title IV-E Training Funds.“ Journal
of Human Behavior in the Social Environment (forthcoming).
Gansle, Kristin and Bert Ellett. ’Louisiana Title IV-E Program Begins
Evaluation Process.“ Partnerships for Child Welfare, Vol. 5, No. 5.
February 1998.
Graef, Michelle I. and Erick L. Hill. ’Costing Child Protective
Services Staff Turnover.“ Child Welfare. Sept/Oct. 2000.
Jones, Loring P. and Amy Okamura. ’Reprofessionalizing Child Welfare
Services: An Evaluation of Title IV-E Training.“ Research on Social
Work Practice. September 2000.
Malm, Karin, et al. Running to Keep in Place: The Continuing Evolution
of Our Nation‘s Child Welfare System. Urban Institute, Occasional Paper
Number 54. October 2001.
Meyer, Lori. ’State Incentive Programs for Recruiting Teachers. Are
They Effective in Reducing Shortages?“ Issues in Brief, National
Association of State Boards of Education. October 2002.
The Network for Excellence in Human Services. Workforce Analysis for
Riverside County Department of Public Social Services. October 2001.
The Network for Excellence in Human Services. Workforce Analysis for
Imperial County Department of Social Services. March 2001.
New York State Office of Children and Family Services, Bureau of
Training. 2001 Caseworker Turnover Survey. May 2002.
Pasztor, Eileen Mayers, et al. Demand for Social Workers in California.
California State University, Long Beach. April 2002.
Robin, S. and C.D. Hollister. ’Career Paths and Contributions of Four
Cohorts of IV-E Funded MSW Child Welfare Graduates.“ Journal of Health
and Social Policy, Vol. 15, No. 3/4. 2002.
Scannapieco, Maria and Kelli Connell-Carrick. ’Do Collaborations with
Schools of Social Work Make a Difference for the Field of Child
Welfare? Practice, Retention, and Curriculum.“ Journal of Human
Behavior in the Social Environment. 2003.
South Carolina Association of Children‘s Homes and Family Services.
Comparative Study of Salaries and Benefits of Direct Care Workers in
Member Agencies and Selected South Carolina State Government Positions.
Lexington, S.C.: January 2000.
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Children and Families, Administration for Children, Youth, and
Families, Children‘s Bureau. Changing Paradigms of Child Welfare
Practice: Responding to Opportunities and Challenges. 1999 Child
Welfare Training Symposium. June 1999.
U.S. Department of Health and Human Services, Administration for
Children and Families, Administration for Children, Youth, and
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Children‘s Bureau. National Survey of Child and Adolescent Well Being
(NSCAW). State Child Welfare Agency Survey: Report. June 2001.
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General, Office of Evaluation and Investigations. Accreditation Of
Public Child Welfare Agencies. March 1994. OEI-O4-94-00010.
U.S. Department of Labor, Bureau of Labor Statistics. 2000 National
Occupational Employment and Wage Estimates.
Zlotnik, Joan Levy. ’Enhancing Child Welfare Service Delivery:
Promoting Agency-Social Work Education Partnerships.“ Policy and
Practice, Vol. 59, No. 1. 2001.
Zlotnik, Joan Levy. ’Selected Resources on the Efficacy of Social Work
for Public Child Welfare Practice.“ Council on Social Work Education,
June 11, 1999.
[End of section]
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FOOTNOTES
[1] States and/or counties may also subcontract the delivery of child
welfare services, such as family support services or adoption planning,
to private agency providers.
[2] Child welfare caseworkers are considered caseworkers, case
managers, investigators, or child welfare specialists, depending on
their particular agency‘s classification scheme.
[3] Exit interviews seek to obtain information from employees on why
they are leaving their current positions. Such interviews may be
conducted orally or through use of a written survey, and their design
and content vary widely across jurisdictions. One limitation of these
interviews is that workers may not be candid in their disclosure of
information because they do not wish to sever relationships with
coworkers and managers.
[4] HHS reviewed an additional five states in fiscal year 2002, but
these reports were not released in time for our analysis.
[5] Child Welfare League of America ’Minimum Education Required by
State Child Welfare Agencies, Percent, By Degree Type, 1998.“ State
Child Welfare Agency Survey. 1999
[6] Albers, E. et al (1993). ’Children in foster care: Possible factors
affecting permanency planning.“ Child and Adolescent Social Work
Journal, 10(4). Dhooper, S.S., et al (1990). ’Does social work
education make a difference?“ Social Work, 35(1).
[7] Under the Social Security Act [42 U.S.C. §674(a)(3)(a)], the
federal government reimburses 75 percent of states‘ training
expenditures related to foster care and adoption services. Pursuant to
HHS regulations, states providing training for contracted private
agency staff can receive 50 percent federal reimbursement for this
purpose.
[8] The District of Columbia, Massachusetts, and Puerto Rico have not
participated in
Title IV-E reimbursements for at least the last 2 fiscal years.
[9] Although the other discretionary grant programs fund initiatives
that can involve caseworker training, caseworker training and
development is not their primary focus.
[10] In commenting on a draft of this report, HHS noted that the CFSR
assesses state performance on 23 measures, which make up the seven
outcomes related to safety, permanency, and well-being in cases and an
additional 22 measures, which make up the seven federally required
system factors that states must have in place by federal law and/or
regulation.
[11] These provisions were originally introduced by both the House and
the Senate in the 107TH Congress as the ’Keeping Children and Families
Safe Act of 2002,“ H.R. 5601 and S. 2998.
[12] These provisions were originally introduced in the 107TH Congress
as part of the Child Protection Services Improvement Act, H.R. 1371.
[13] According to our analysis and categorization of exit interview
documents obtained, the top five reasons child welfare workers gave for
leaving were: other--including retirement, stay at home, return to
school, and undisclosed personal reasons (59.15 percent); stress/
burnout/workload (14.7 percent); inadequate compensation (13.85
percent); alternate employment (13.5 percent); and relocation (10.77
percent).
[14] Most states require teachers to take multiple state certification
examinations in order to become certified to teach in certain subject
areas. However, qualifications for teachers vary by state, and the
current debate centers around permitting uncertified teachers to teach
while receiving their training at night or on weekends.
[15] U.S. Department of Labor, Bureau of Labor Statistics. 2000
National Occupational Employment and Wage Estimates.
[16] This amount is specific to child, family, and school social
workers (the occupation under which caseworkers would likely be
classified).
[17] California Alliance of Child and Family Services. Comparison of
Foster Care Funding for the Wages of Child Care Workers and Social
Workers in Group Homes with Wages in Other Occupations. July 1, 2001.
[18] South Carolina Association of Children‘s Homes and Family
Services. Comparative Study of Salaries and Benefits of Direct Care
Workers in Member Agencies and Selected South Carolina State Government
Positions. Lexington, S.C. January 2000.
[19] New York State Office of Children and Family Services, Bureau of
Training. 2001 Caseworker Turnover Survey. May 2002.
[20] American Federation of State, County, Municipal Employees. Double
Jeopardy: Caseworkers at Risk Helping At-Risk Children: A Report on the
Working Conditions Facing Child Welfare Workers, 1998.
[21] American Public Human Services Association. Report from the Child
Welfare Workforce Survey: State and County Data and Findings, May 2001.
[22] Among other things, labor unions work to improve the availability
and quality of support services, promote continuing education, and
foster effective staff relationships with management.
[23] Malm, Karin, et al. Running to Keep in Place: The Continuing
Evolution of Our Nation‘s Child Welfare System. Urban Institute,
Occasional Paper Number 54, October 2001.
[24] Network for Excellence in Human Services. Workforce Analysis for
Riverside County Department of Public Social Services. October 2001.
[25] Network for Excellence in Human Services, Workforce Analysis for
Imperial County Department of Social Services. March 2001.
[26] HHS officials told us that Child Abuse Prevention and Treatment
Act funds are available for this type of training.
[27] ASFA allows for various exemptions from the 15-of 22-month
provision. Under ASFA, states are not required to file for a TPR if the
child is being cared for by a relative; the state documents a
compelling reason why filing a petition to terminate parental rights is
not in the child‘s best interests; or the state has not provided
services needed to make the home safe for the child‘s return.
[28] Of the 10 available PIPs, five states include specific measures to
address high caseloads, inadequate staffing levels, and new worker
training.
[29] The relationship between state agencies and the universities with
which they partner varies by state. Some partnerships are more
collaborative than others; in some states the agency acts only as a
conduit of federal dollars, while in others, agencies work with schools
of social work to shape the curriculum and design the internship
program. In commenting on a draft of this report, ACF said that HHS‘s
child welfare training grant program has fostered stronger partnerships
by requiring schools of social work to collaborate with state child
welfare agencies in designing their programs.
[30] Robin, S.C, and C.D. Hollister. Career Paths and Contributions of
Four Cohorts of IV-E Funded MSW Child Welfare Graduates. School of
Social Work, Journal of Health and Social Policy, vol. 15, no.3/4
(2002).
[31] Fox, S., Miller, V. & Barbee, A.P. Finding and Keeping Child
Welfare Workers: Effective Use of Title IV-E Training Funds. Journal of
Human Behavior in the Social Environment (forthcoming).
[32] Jones, Loring P. and Amy Okamura. ’Reprofessionalizing Child
Welfare Services: An Evaluation of Title IV-E Training.“ Research on
Social Work Practice, September 2000. Ongoing research in Louisiana
also found similar results. IV-E participants score higher on child
welfare competency exams than control groups, have higher rates of
retention within the agency, and score higher on supervisor evaluations
of their work preparation (Ellett, Bert and Kristin Gansle. ’Louisiana
Title IV-E Program Begins Evaluation Process.“ Partnerships for Child
Welfare, Vol. 5, No.5. February 1998).
[33] Agencies‘ capacities to meet and comply with COA accreditation
standards are assessed through a formal review process. Accredited
agencies are reevaluated at least every 4 years to maintain their
status.
[34] As of December 2002, there were 1,090 accredited private child
welfare agencies. In addition to Illinois and Kentucky, whose entire
systems are accredited, 12 states have at least one accredited county
or local child welfare office.
[35] A receivership is an arrangement in which a court appoints a
person to temporarily manage a local agency with broad authority to
ensure full compliance with the court order in an expeditious manner.
[36] U.S. Department of Health and Human Services, Office of Inspector
General, Office of Evaluation and Inspections. Accreditation of Public
Child Welfare Agencies. March 1994. OEI-O4-94-00010.
[37] Although accredited agencies are required to submit yearly
Maintenance of Accreditation reports to COA, according to one COA
official, there is no mechanism in place to certify agencies‘
compliance with the accrediting standards on a daily or monthly basis.
[38] In commenting on a draft of this report, ACF noted that it has
fostered the identification of caseworker competencies by requiring
clear delineation of worker competencies as a basis for curriculum
development in announcements for child welfare training fund proposals.
[39] Meyer, Lori. ’State Incentive Programs for Recruiting Teachers.
Are They Effective in Reducing Shortages?“ Issues in Brief, National
Association of State Boards of Education, October 2002.
[40] Of the 444 county agencies in our sample, 100 were intentionally
selected--to ensure adequate representation of urban and rural areas--
because they are located in the 5 least populated and 5 most populated
counties in each of the 10 states, and 344 were selected through
randomization of each state‘s remaining midsize counties.
[41] The eleventh county-administered state--California--sent our
survey to all 58 of its counties.
[42] These numbers do not include agencies that were willing to share
exit interviews with us but had no staff leave during the specified
period.
[43] Some agencies--originally indicating that they were willing to
share their exit interview documents--did not do so, while other
agencies--originally unwilling to share their documents--ultimately
provided them.
[44] HHS reviewed an additional five states in fiscal year 2002, but
these reports were not available at the time of our analysis.
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