Perceived Welfare Caseworker Support and Psychological Distress among Low-Income Urban Women with Children

Although some research suggests that the relationship between Child Protective Services (CPS) workers and their clients may influence client outcomes, little is known about the function of the relationship between welfare or Temporary Assistance for Needy Families (TANF) caseworkers and their clients. This article reviews what is currently know about the effects of relationship quality between CPS workers and their clients and extends the knowledge base to include welfare caseworker support and psychological distress among a sample of predominately minority low-income urban women with children. LITERATURE REVIEW Outcomes of Worker-Client Relationship Quality The connection between doctor-patient and therapist-client relationship quality and client outcomes has been convincingly explored. Factors such as empathy and warmth have been shown to correlate more highly with client outcomes than do specialized therapeutic treatment interventions (Lambert & Barley, 2001), and patients who feel they are listened to by their physicians are less likely to avoid treatment for both medical and psychological problems (Moore et al., 2004). However, researchers have only begun to investigate the connection between CPS worker-client and welfare worker-client relationships and client outcomes, and virtually nothing is known about worker-client relationship quality and psychological distress among clients. Most of the evidence concerning outcomes of CPS worker and client relationships is qualitative in nature and suggests that relationship qualities--including cooperative and collaborative problem solving, good listening skills, empathic understanding, emphasis on solutions and strengths, and flexibility--may contribute to earlier case closure and favorable case outcomes (Maiter, Palmer, & Manji, 2006; Richardson, 2008; Trotter, 2002; Tuttle, Knudson-Martin, Levin, Taylor, & Andrews, 2007). Trotter (2002) investigated the extent of worker skill and client outcomes in a qualitative study of 282 Australian child protection clients (including 50 adolescents who were the subjects of the child protection intervention, 112 mothers, 69 fathers, and 42 other relatives or friends) and 50 child protection workers involved in the client cases. He reported that workers who use a collaborative worker-client relationship to help clients and their families to understand the role of the child protection worker, who use problem solving that focuses on the client's definitions of problems, who reinforce prosocial expressions and actions, and who make appropriate use of confrontation have more satisfied clients who achieve better outcomes, including having their cases closed within a 16-month period. Using themes that emerged from in-depth interviews with eight substance-abusing mothers in the child welfare system, Sun (2000) outlined what she called the "journey of recovery." Mothers in this study reported that child welfare system intervention was both a crisis and a turning point for them--an opportunity to break a vicious cycle and enter the mainstream world. Mothers in the study reported a desire for a better life, meaningful relationships, and self-actualization. They reported that having a CPS worker who was nonjudgmental and nonauthoritative, who cared about and had faith in their abilities to be successful, who established feasible case plans that treated both mother and child as one unit, who facilitated and strengthened the use of social networks (including self-help groups), and who provided case management and life-skills training were key to their success in achieving those ends. Taken together, these studies suggest a growing interest in and support for the quality of CPS worker-client relationships and improved client outcomes. Partly due to recent policy shifts and corresponding job chances for welfare workers, far less is known about the association between welfare worker-client relationships and client mental health. …