Friday, February 27, 2015

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.

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