The Impact of Busywork on Social Worker Productivity and Retention

One of the most stressful aspects of being a social worker in DC's child welfare system is the waste of precious time on tasks that do not benefit the client. When I worked in the system, I came to work every day with a long to-do list chock full of things that needed to be done for my clients--like completing a referral form so a client could get therapy or visiting a relative who might be able to take a client into her home. But I was often forced put these tasks aside in order to jump through bureaucratic hoops. Behind each of these hurdles is a legitimate purpose, but the mechanism adopted is either irrelevant to the purpose or goes too far. Let me just give you a few examples.

Every child in the system is required to have a case plan, which has to be redone every six months. That is required by federal law and actually makes sense. The case plan is supposed to outline what each party in the case is supposed to do in order to achieve the planned result. If social workers could develop the case plan with the child, the family, and the foster parents, it might actually be a useful document. Unfortunately, that is not the case. The plans have to be developed in FACES, the child welfare system's electronic database, which runs only on an obsolete version of Microsoft Internet Explorer, so the case plans cannot be developed with the family on a visit by the social worker. To complete a case plan for a child with a goal of family reunification, the social worker must spend up to two hours checking off boxes and filling in blanks on the computer. The final product, when printed out, is generally about ten pages long and is basically gibberish and extraneous information. It has to be signed in in two places by the birth parent or foster parent and the child over 14. Most social workers do not bother to go over the case plan but simply ask the client to sign it. There is no reason why case plans could not be completed on paper by social workers with their clients, except that having the form in the database allows easy monitoring of private agencies and units of the Child and Family Services Agency (CFSA).

In addition to the case plan, all foster youth aged 15 and older must have a Youth Transition Plan. There has been increasing concern about foster youth aging out of care and ending up homeless and without work or educational credentials. In order to ensure that youths are prepared to age out of care, social workers are required to hold meetings every six months from when the youth turns 15 in order to produce a youth transition plan. When I first started as a social worker, these plans were actually useful. We had a template that was divided into different areas, like education, employment, health, etc. and for each area the plan had to list the planned actions, who was responsible, and the deadline. I brought the plan along when I met with my clients and it was an easy way to check up on how they were doing and to remind each team member of what he or she had agreed to do. Unfortunately, CFSA decided in 2014 that we had to use the new “Transition Toolkit, which is 36 pages and consists of over ten separate forms. It is so complicated that CFSA eventually distributed at two-page guide to social workers outlining all the steps involved in preparing a transition plan for a youth. Using the plan was so difficult that CFSA eventually stopped requiring completion of the individual forms and instead allowed workers to cut and paste a short section of each form together, essentially recreating the previous template, in a much more cumbersome and time-consuming form.

Another required but useless task is the requirement that social workers spend an hour per client being interviewed by a placement worker to develop a “Child Needs Assessment (CNA).” The “CNA” is a tool that collects information about the child's characteristics and needs that is designed to match the child with an appropriate placement. Unfortunately, agency policy requires that these be completed for every foster child after 30 days in care, then every 90 days for young people in therapeutic foster care and every 180 days for clients in traditional foster care, regardless of whether the child needs a new placement. Unless the worker happens to have a client needing a new placement exactly 90 or 180 days after the last “CNA” was filled out, she will also have to complete another one if a new placement is needed. I do not know how many times I have had to stop doing something important in order to spend an hour on the phone with a placement specialist in order to complete the “CNA” on time. The form is then filed away, never to be seen again. Three or six months later, the process starts again with the same questions, like why the child came into care—something that would not have changed since the last form was filled out! The LaShawn Exit Standards (required for CFSA to exit court supervision), require only that a “CNA” be completed when a new placement is required. This would actually make sense. It is not clear why CFSA is insisting on the broader use of this form.

A major priority of CFSA is to ensure that its wards get proper medical care. However, because this concern is taken far beyond its logical conclusion, wards of the city often are medically screened many times a year, or often several times a month, resulting in missed school for the clients and wasted time for social workers and case aides. All children who come into foster care are screened before placement at Healthy Horizons, CFSA's in-house clinic. This initial screening makes sense, as many have been medically neglected and need immediate treatment for various medical conditions. However, all children must return to the clinic within two weeks, accompanied by a social worker or family support worker, for a “comprehensive screening.” This is basically an annual physical without the shots, so if the child does need shots, she must be brought for a physical at a clinic or doctor's office as well. That physical cannot be used to substitute for the screening at CFSA. Even if a child has had a physical within the last year and documentation has been obtained, the child is still required to have a the comprehensive screening at CFSA within 14 days of entering care. Wait, it gets better. Every time the child changes placements, even if it is for a “respite placement” of a few days, he or she must be screened again! One one occasion, a client entered a respite placement that was supposed to last for a month while her foster parent recovered from heart surgery. The respite changed into a regular placement when the original foster parent suffered complications and could not take the child back. Because the placement changed from respite to regular, the client had to have another screening at the clinic, even though she remained in the same home.

Just to make things even more fun, the CFSA clinic closes from 1:00 to 2:00 for lunch every day no matter how many children are waiting. The last time I was there, it was with four children and we got there at 11:00—a bad choice. We waited for an hour before one of the children was seen. The clinic then closed for an hour. We could not go out to lunch because we might lose our place on line, but we were not allowed to eat at the facility. (We did anyway). I think we got out at 4:00. I certainly envied the clinic staff. They might be idle all morning until a client comes in at 12:30 but they still get to go for lunch at 1:00. I don't recall when I last had a lunch break as a social worker.

I have listed just a few of the procedures that waste social workers' time when they could be making sure their clients have the appropriate services and get out of care as soon as possible. None of these time-wasting procedures are required in their current form by the federal government and only the health exams at each new placement are required by the LaShawn exit standards (which I hope can be renegotiated). As I have indicated, each of these procedures has a legitimate goal behind it. But the required procedures are either so badly designed that they do not contribute to achievement of the goal at all (like the case plan) or are taken to such an extreme that they detract from the achievement of other goals (like the multiple health exams) . Unfortunately, not only does this busywork prevent social workers from doing what really matters. It also results in the loss of many great social workers. I have just learned (through the response to my Freedom of Information Act request) that CFSA has a social worker turnover rate of 17.3% annually. Perhaps this turnover rate would be lower if there would be less meaningless busywork that interferes with a social worker's ability to help his or her clients.

Response to Agency Testimony

On February 18, 2015, the DC Council held an oversight hearing on the Child and Family Service Agency (CFSA)'s performance in the current fiscal year. I have already posted my testimony at this hearing. In this post, I respond to CFSA's testimony, delivered by Interim Director Raymond Davidson.

In its testimony, CFSA congratulated itself for bringing down the percentage of children who are in group homes, independent living, or residential care, so that 83% of its wards are in the homes of relatives or licensed foster parents. In my testimony, I raised the concern that many of these homes are not providing the nurturing and attention that these fragile children need. I talked about my personal experience with foster parents who have never visited the child's school, talked to their therapist, or brought them to the doctor. Ideally, most children would be placed in foster families rather than congregate care settings like group homes. But children with complex problems need a truly therapeutic foster home, based on a proven model, in which foster parents are provided with extensive supports, treated as professional team members, and expected to implement precisely tailored treatment interventions and participate in frequent meetings and calls. .The District lacks this type of treatment foster care program. (See Rebecca Brink, Improving the Children's Mental Health System in the District of Columbia. Children's Law Center, May 9, 2012. Available from childrenslawcenter.org). The District's so-called “therapeutic foster homes” are just regular foster homes that are paid more because the children are considered to be harder to serve. The District also needs more family-style group homes to provide the intensive attention and supervision that many of our older youth need.

Director Davidson lauded CFSA's transformation from “a system with a high child removal rate and geared primarily for foster care” to “a system focused on strengthening families and keeping them together.” This is definitely a good thing as long as the children are kept safe. The question is whether the children who are kept at home, and their families, are receiving adequate services. Other witnesses expressed this concern. I have heard anecdotal information that children who are finally being removed are more disturbed because they have been kept too long in extremely abusive or neglectful homes. Child welfare is always struggling with the balance between too many and too few removals, then changing course after a disaster like a death of a child who was not removed. Let us hope that will not be the case in the District of Columbia.

The Director boasted that “Over the past two years, CFSA has worked with national experts to train nearly 3,000 child-serving professionals....in the cutting edge techniques of Trauma Systems therapy (or TST).” He stated that CFSA is “now at the point of introducing a set of screening and assessment tools that will aid social workers in identifying child, youth, and caregiver issues and strengths and point them toward service pathways that will help and heal.” So after two years and 3,000 professionals trained (I myself underwent two full days plus four hours of in-person training and six hours of teleconferences), they have not introduced any tools yet. Moreover, I learned in the most recent training session that they were still modifying the tools that they had introduced almost two years ago. It seems like a lot of money down the drain.

In my oral testimony, I raised concerns about the closure of two private agencies as of the end of February. I stated that the two agencies that are closing (Foundations for Home and Community[“Foundations”] and KidsPeace) are not those with the worst reputations among professionals in the system. Director Davidson assured the Committee that the closed agencies are those that scored the lowest on performance. But I still have doubts. CFSA stopped posting the “performance scorecards” for private agencies after September 2013. I have filed a Freedom of Information Act for the actual performance scorecards that were prepared after that time and also for the specific data that CFSA used in making its decision. I know that exits to permanent homes are given a lot of weight. But since Foundations took the oldest and most troubled children, many of whom have been in the system for years, they cannot be expected to achieve permanence at the rate of other agencies. Moreover, exits to permanence should not be measured on a quarterly basis—if that is what CFSA is doing.

I also expressed concern about the young people in Foundations foster homes who may be forced to move because their foster parents will not accept the lower stipends offered by the other private agencies. Director Davidson assured the Committee that CFSA will be extending the contract with Foundations on an individual basis to cover those young people who are close to achieving permanency or who cannot find another placement. That was reassuring, but it still means that those who can find another placement must be moved—even though CFSA is so concerned with minimizing moves between foster homes because of the known negative effect of these moves.

In several instances, I was shocked to learn how little the leadership knows about how CFSA's services actually work. In answer to a question from the Chair, Deputy Director Debra Porcia Usher stated that after children are removed from their families a “Child Needs Assessment (CNA)” is completed to make sure they are matched with the most appropriate foster home. That would be absolutely ideal, but I wonder who would do the CNA (a form which takes an hour) in the middle of the night, when most children seem to come into care. In reality, the placement worker calls around until a foster parent is found who answers the phone and agrees to take the removed child or children based on little or no information. Unfortunately, rather than being used primarily to match children with families, the CNA's are required to be completed quarterly and take at least an hour of a hard-working social worker's time to no evident purpose.

I was also surprised that Deputy Director Michelle Rosenberg thought that the new Catholic Charities Mobile Crisis Services are accessed directly by the foster parent. Actually, the social worker must call the Resource Development Specialist, who then makes the referral to Catholic Charities. The lack of knowledge among agency leadership about how services work is significant. No wonder social workers are hampered by policies and procedures that don't make sense—like completing a “Child Needs Assessment” four times a year rather than only when a child needs a new placement. Everyone at the Deputy Director level should spend at least one day a year shadowing the case-carrying workers who work in the units that they supervise. Then we might see an end to useless and cumbersome requirements and give social workers the time to do their jobs.

Why I Left the DC Child Welfare System

Welcome to my new blog, Fostering Reform. It stems from a desire to share my experience as a social worker in the District of Columbia's foster care system, where I learned how well-meaning policies can often result in unintended consequences. While I will specifically address child welfare policy and practice in the District of Columbia, much of the content will be applicable to other jurisdictions as well, so I hope that practitioners and policymakers outside the District will choose to follow this blog as well. Today I'd like to share with you the testimony that I delivered at yesterday's oversight hearing before the DC Council on CFSA's performance in the current fiscal year. Stay tuned for the next posting, which will describe my reactions to CFSA's testimony.

Testimony of Marie Cohen, LICSW, MPA

At the Performance Oversight Hearing the Child and Family Services Agency (CFSA)

Committee on Human Services

February 18, 2015

My name is Marie Cohen and I was a social worker in the District of Columbia’s foster care system until January 30, 2015. Eight years ago, I gave up my career as a policy analyst and researcher to go to social work school and work in child welfare. I wanted to make a difference to our city’s most vulnerable children. After five years working in the District’s foster care system, I am exhausted, frustrated and depressed. Clearly, working with our city’s most troubled children and families is difficult. But my burnout is due as much to systemic problems as due to the inherent difficulty of the work. I’d like to tell you what I have learned.

As a foster care social worker, I had to spend much of my time complying with numerous requirements which had virtually no benefit for children. Each child in the system is required to have up to three types of multi-page plans, none of which are useful in real life. I was constantly peppered with “urgent” requests for information from desk-bound bureaucrats so that they could complete reports that were then filed away. One more example. Children must undergo a health screening every time they change placements. Even if they are going to respite care for three nights, they have to be re-screened. This can take hours, as the staff of CFSA's clinic will take an hour-long lunch break at 1:00 regardless of whether they are in the middle of examining a child and of how many children are waiting.

Sadly, much of the busywork I have described is due to a twenty-year-old court-case, which has resulted in continuing supervision by an outside agency, the Center for Law and Social Policy. With its focus on process-oriented benchmarks rather than the outcomes that really matter, I believe that the court mandated monitoring is actually hurting children.

It was bad enough that I had to spend so much time engaged in useless paperwork. But it was worse that I had to see clients placed in loveless homes with foster parents who could not be bothered to pick them up from school when they were sick, attend school meetings, or take them to their therapy session. Believe it or not, paid staff usually take the children to therapy so that there is no contact between the foster parent and the therapist. Thankfully, not all foster parents are like this. The best ones treat their charges like their own children. But there are simply not enough people like that today. Instead, many foster parents are providing foster care in order to meet their expenses.

Therapeutic foster parents in the District are supposed be trained to work with more disturbed children and are able and willing to offer more intensive support. Unfortunately, I have seen little difference between “traditional” and “therapeutic” homes and many homes are licensed for both. The Children's Law Center has pointed out that the “therapeutic foster homes” in the District of Columbia are very different from the treatment foster care models that have been shown to be effective. In these models, foster parents are treated as professional team members, provided with extensive supports, and expected to implement precisely tailored treatment interventions and participate in weekly meetings and daily calls.

The District also needs to recognize that some teenagers could benefit from placement in family-style group homes such as those run by Boys Town, in which professionally trained couples care for six to eight children. But these are more expensive, and they violate the accepted wisdom that children should be placed in the “least restrictive setting.” For whatever reason, there are only four such homes in the District of Columbia, and we need more.

I knew that this would be a difficult job when I took it. But I did not realize that much of the difficulty would be imposed by the system itself. The District can do better by streamlining the many requirements that serve no purpose other than satisfying external monitors, implementing an evidence-based therapeutic foster care program for children and youth with mental health issues, and adding more family-style group homes for older and more troubled youth.