Child Welfare: HHS Could Play a Greater Role in Helping Child Welfare Agencies Recruit and Retain Staff
Published: 2003-03-31T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: 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.
section_title: What GAO Found
paragraphs: 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.

section_title: Letter
paragraphs: 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, 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 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.  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 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.
subsections: section_title: Background
paragraphs: 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, 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. 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— 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. 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; 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).
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. 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.
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.  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.  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.
section_title: Public and Private Child Welfare Agencies Face Challenges in Recruiting and Retaining Workers and Supervisors
paragraphs: 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.
subsections: section_title: Low Salaries Hinder Agencies’ Ability to Maintain a Stable Workforce
paragraphs: 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. 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. The  Bureau of Labor Statistics’ national wages survey reports that elementary  and middle school teachers earn, on average, about $42,000 annually while  social workers earn about $33,000. 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. 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. 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. 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), 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.
section_title: High Caseloads, Administrative Burdens, Limited Supervision, and Insufficient Training Reduce the Appeal of Child Welfare Work
paragraphs: 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, 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.
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,  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. 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. 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.
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, 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.
section_title: Some Evidence Suggests How Recruitment and Retention Challenges Affect Children’s Safety and Permanency, but the Magnitude of the Effect Is Unknown
paragraphs: 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.
subsections: section_title: Agency Staff Shortages and High Caseloads Impair Caseworkers’ Abilities to Perform Critical Case Management Activities
paragraphs: 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.
section_title: Child and Family Services Reviews Show That Workforce Deficiencies Hamper Agencies’ Attainment of Federal Child Welfare Outcomes
paragraphs: 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.
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. 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.
section_title: Agencies Have Implemented Various Workforce Practices, but Few Have Been Fully Evaluated
paragraphs: 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.
subsections: section_title: University-Agency Partnerships Appear to Improve Recruitment and Reduce Turnover
paragraphs: 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. 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. 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.
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.  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.
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.
section_title: Systemic Improvements in Managing Child Welfare Cases Help Alleviate Worker Stress
paragraphs: 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.
subsections: section_title: Accreditation
paragraphs: 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. Only two states—Illinois and Kentucky— have fully accredited child welfare systems, 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. 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, while many agencies that receive accreditation may be performing  well already, accreditation status does not guarantee high-quality service.  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.
section_title: Enhancements to Supervision and Mentoring
paragraphs: 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.
section_title: Use of Hiring Competencies, Realistic Job Previews and Recruitment Bonuses May Enhance Agencies’ Abilities to Hire Qualified Staff
paragraphs: 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.
subsections: section_title: Matching Recruits’ Competencies and Expectations with Agency Needs
paragraphs: 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. 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.
section_title: Using Bonuses to Attract and Retain Caseworkers
paragraphs: 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, 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.
section_title: Conclusion
paragraphs: 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.
section_title: Recommendation
paragraphs: 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.
section_title: Agency Comments
paragraphs: 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.
section_title: Appendix I: Scope and Methodology
paragraphs: 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 in each of 10 county-administered states. 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. 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. 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. 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.
section_title: Appendix II: Selected Council on Accreditation for Children and Family Services Standards
paragraphs: Appendix II: Selected Council on  Accreditation for Children and Family  Services Standards  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.  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.  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.  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.  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.
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.  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.  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.  Caseloads for direct care personnel do not exceed 12 residents.  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.
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.  The maximum supervisor to caseworker ratio is 1:5.  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.
section_title: Appendix III: Comments from the Department of Health and Human Services
section_title: Appendix IV: GAO Contacts and Acknowledgments
subsections: section_title: GAO Contacts
section_title: Acknowledgments
paragraphs: 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.
section_title: Bibliography
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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.
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section_title: Related GAO Products
paragraphs: Foster Care: Recent Legislation Helps States Focus on Finding  Permanent Homes for Children, but Long-Standing Barriers Remain.  GAO-02-585. Washington, D.C.: June 28, 2002.
District of Columbia Child Welfare: Long-Term Challenges to Ensuring  Children’s Well-Being. GAO-01-191. Washington, D.C.: December 29, 2000.
Child Welfare: New Financing and Service Strategies Hold Promise, but  Effects Unknown. GAO/T-HEHS-00-158. Washington, D.C.: July 20, 2000.
Foster Care: States’ Early Experiences Implementing the Adoption and  Safe Families Act. GAO/HEHS-00-1. Washington, D.C.: December 22, 1999.
Foster Care: HHS Could Better Facilitate the Interjurisdictional  Adoption Process. GAO/HEHS-00-12. Washington, D.C.: November 19,  1999.
Foster Care: Effectiveness of Independent Living Services Unknown.  GAO/HEHS-00-13. Washington, D.C.: November 10, 1999.
Foster Care: Kinship Care Quality and Permanency Issues. GAO/HEHS- 99-32. Washington, D.C.: May 6, 1999.
Juvenile Courts: Reforms Aim to Better Serve Maltreated  Children. GAO/HEHS-99-13. Washington, D.C.: January 11, 1999.
Child Welfare: Early Experiences Implementing a Managed Care  Approach. GAO/HEHS-99-8. Washington, D.C.: October 21, 1998.
Foster Care: Agencies Face Challenges Securing Stable Homes for  Children of Substance Abusers. GAO/HEHS-98-182. Washington, D.C.:  September 30, 1998.
Child Protective Services: Complex Challenges Require New Strategies.  GAO/HEHS-97-115. Washington, D.C.: July 21, 1997.
Foster Care: State Efforts to Improve the Permanency Planning Process  Show Some Promise. GAO/HEHS-97-73. Washington, D.C.: May 7, 1997.
Foster Care: State Efforts to Expedite Permanency Hearings and  Placement Decisions. GAO/T-HEHS-97-76. Washington, D.C.: February 27,  1997.
Child Welfare: States’ Progress in Implementing Family Preservation  and Support Activities. GAO/HEHS-97-34. Washington, D.C.: February 18,  1997.
Permanency Hearings for Foster Children. GAO/HEHS-97-55R.  Washington, D.C.: January 30, 1997.
Child Welfare: Complex Needs Strain Capacity to Provide Services.  GAO/HEHS-95-208. Washington, D.C.: September 26, 1995.
Child Welfare: Opportunities to Further Enhance Family Preservation  and Support Activities. GAO/HEHS-95-112. Washington, D.C.: June 15,  1995.
Foster Care: Health Needs of Many Young Children Are Unknown and  Unmet. GAO/HEHS-95-114. Washington, D.C.: May 26, 1995.