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entitled 'Child Welfare: HHS Could Play a Greater Role in Helping Child 
Welfare Agencies Recruit and Retain Staff' which was released on March 
31, 2003.



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Report to Congressional Requesters:



United States General Accounting Office:



GAO:



March 2003:



Child Welfare:



HHS Could Play a Greater Role in Helping Child Welfare Agencies Recruit 

and Retain Staff:



GAO-03-357:



GAO Highlights:



Highlights of GAO-03-357, a report to Congressional Requesters



Why GAO Did This Study:



A stable and highly skilled child welfare workforce is necessary to 

effectively provide child welfare services that meet federal goals. 
This 

report identifies (1) the challenges child welfare agencies face in 

recruiting and retaining child welfare workers and supervisors, (2) how 

recruitment and retention challenges have affected the safety and 

permanency outcomes of children in foster care, and (3) workforce 

practices that public and private child welfare agencies have 
implemented 

to successfully confront recruitment and retention challenges.



What GAO Found:



Child welfare agencies face a number of challenges in recruiting and 

retaining workers and supervisors. Low salaries, in particular, hinder 

agencies’ ability to attract potential child welfare workers and to 
retain 

those already in the profession. Additionally, caseworkers GAO 
interviewed 

in all four of the states GAO visited cited high caseloads and related 

administrative burdens, which they said took from 50 to 80 percent of 

their time; a lack of supervisory support; and insufficient time to 
take 

training as issues impacting both their ability to work effectively and 

their decision to stay in the child welfare profession. Most of these 

issues also surfaced in GAO’s analysis of 585 exit interviews completed 
by 

child welfare staff across the country who voluntarily severed their 

employment. 



According to caseworkers GAO interviewed, high turnover rates and 
staffing 

shortages leave remaining staff with insufficient time to establish 

relationships with children and families and make the necessary 
decisions 

to ensure safe and stable permanent placements. GAO’s analysis of HHS’s 

state child welfare agency reviews in 27 states corroborated caseworker 

accounts, showing that large caseloads and worker turnover delay the 

timeliness of investigations and limit the frequency of worker visits 
with 

children, hampering agencies’ attainment of some key federal safety and 

permanency outcomes.



Child welfare agencies have implemented various workforce practices to 

improve recruitment and retention—including engaging in university-
agency 

training partnerships and obtaining agency accreditation, a goal 
achieved 

in part by reducing caseloads and enhancing supervision—but few of 
these 

initiatives have been rigorously evaluated.



What GAO Recommends:



GAO recommends that the Secretary of Health and Human Services (HHS) 
take 

actions that may help child welfare agencies address the recruitment 
and 

retention challenges they face. Such efforts may include HHS (1) using 
its 

annual discretionary grant program to promote targeted research on the 

effectiveness of perceived promising practices; and/or (2) issuing 

guidance or providing technical assistance to encourage states to use 

their program improvement plans to address the caseload, training, and 

staffing issues cited in the reviews HHS conducts.



www.gao.gov/cgi-bin/getrpt?GAO-03-357



To view the full report click on the link above. For more information, 

contact Cornelia Ashby at (202) 512-8403 or Ashbyc@GAO.gov.



[End of section]



Contents:



Letter:



Results in Brief:



Background:



Public and Private Child Welfare Agencies Face Challenges in Recruiting 

and Retaining Workers and Supervisors:



Some Evidence Suggests How Recruitment and Retention Challenges Affect 

Children’s Safety and Permanency, but the Magnitude of the Effect Is 

Unknown:



Agencies Have Implemented Various Workforce Practices, but Few Have 

Been Fully Evaluated:



Conclusion:



Recommendation:



Agency Comments:



Appendix I: Scope and Methodology:



Appendix II: Selected Council on Accreditation for Children and Family 

Services Standards:



Appendix III: Comments from the Department of Health and Human 
Services:



Appendix IV: GAO Contacts and Acknowledgments:



GAO Contacts:



Acknowledgments:



Bibliography:



Related GAO Products:



Tables:



Table 1: CFSR Assessment Measures Whose Attainment was Affected by 

Workforce Deficiencies in 5 or More of the

27 States Reviewed:



Table 2: BSW And MSW Programs Offered through Agency-University 

Partnerships in Four States:



Table 3: Staff Qualifications:



Table 4: Supervisor Qualifications:



Table 5: Caseload Limitations:



Table 6: Supervisor-to-Staff Ratios:



Figures:



Figure 1: Distribution of Discretionary Grant Funds for Child Welfare 

Services:



Figure 2: Major Channels of Federal Funding for Staff Development:



Figure 3: Comparison of Average and Individual Child Welfare Worker 

Caseloads to Recommended Standards:



Abbreviations:



ACF: Administration for Children and Families:



AFSCME: American Federation of State, County, and Municipal

 Employees:



APHSA: American Public Human Services Association:



ASFA: Adoption and Safe Families Act of 1997:



BSW: Bachelor’s of Social Work:



CFSR: Child and Family Services Review:



COA: Council on Accreditation for Children and Family Services:



CWLA: Child Welfare League of America:

HHS: Health and Human Services:



MSW: Master’s of Social Work:



PIP: program improvement plan:



TPR: termination of parental rights:



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copyrighted materials separately from GAO’s product.



United States General Accounting Office:



Washington, DC 20548:



March 31, 2003:



The Honorable Pete Stark

The Honorable James Greenwood

House of Representatives:



With more than 800,000 children estimated to spend some time in foster 

care each year, the federal government allocates approximately $7 

billion each year to states to investigate abuse and neglect, provide 

placements to children outside their homes, and deliver services to 

help keep families together. In addition to this funding, most of which 

is used by states and counties to implement child welfare 

programs,[Footnote 1] the Department of Health and Human Services (HHS) 

monitors states’ compliance with key federal goals, specified in part 

by the Adoption and Safe Families Act (ASFA) of 1997, to keep children 

safe and ensure their placement in stable and permanent homes. Through 

its formal review process, known as the Child and Family Services 

Review (CFSR), HHS uses specific assessment measures, such as agencies’ 

ability to conduct timely abuse and neglect investigations and 

regularly visit children in their homes, to assess the performance of 

states’ child welfare systems. HHS also provides guidance and technical 

assistance through its 10 national resource centers and funds training 

and research activities to improve child welfare services nationwide.



A stable and highly skilled child welfare workforce is necessary to 

effectively provide child welfare services that meet federal goals. 

Many child welfare caseworkers[Footnote 2] have professional degrees in 

social work; however, this credential is not always required and many 

practicing in child welfare have undergraduate degrees in seemingly 

unrelated fields. Although the federal government has not set national 

workforce standards, independent organizations such as the Child 

Welfare League of America (CWLA) have developed guidelines concerning 

staff qualifications and optimal caseload levels, which agencies may 

voluntarily adopt. Agencies may also seek accreditation--a voluntary 

review and 4-year certification process by the Council on Accreditation 

for Children and Family Services (COA)--to help improve the delivery of 

child welfare services.



You asked us to identify (1) the challenges these agencies face in 

recruiting and retaining child welfare workers and supervisors, (2) 

what is known about how recruitment and retention challenges have 

affected children’s safety and permanency outcomes, and (3) workforce 

practices that public and private child welfare agencies have 

implemented to confront these challenges.



To conduct our work, we obtained nearly 600 exit interview documents 

completed by staff who severed their employment from 17 state, 

40 county, and 19 private child welfare agencies and categorized the 

reasons these former caseworkers provided for leaving their 

jobs.[Footnote 3] Although the results of our exit interview analysis 

are informative, we cannot generalize the results nationwide. We also 

examined the available 27 Child and Family Services Reviews[Footnote 4] 

and a variety of child welfare workforce studies to determine the 

severity and scope of recruitment and retention challenges across the 

country. To complement these analyses, we interviewed child welfare 

experts and officials across the nation and conducted multiple site 

visits to public and private child welfare agencies in four states--

California, Illinois, Kentucky, and Texas--to obtain first hand 

information on workforce issues and their effect on children’s safety 

and permanency outcomes. We selected these states to represent a range 

of urban and rural settings, county and state-administered systems, and 

varying degrees of reliance on private child welfare agencies to 

deliver services under contract. We also chose these states for the 

variety of practices they have implemented to address their recruitment 

and retention challenges. Furthermore, we contacted regional and 

headquarters officials at HHS to identify and obtain any information 

they had collected or disseminated on this topic and the impact of 

federal funding to support child welfare staff development. We 

conducted this work between March 2002 and January 2003 in accordance 

with generally accepted government auditing standards. A more detailed 

discussion of our scope and methodology appears in appendix I.



Results in Brief:



Public and private child welfare agencies face a number of challenges 

recruiting and retaining workers and supervisors. Low salaries, in 

particular, hinder agencies’ ability to attract potential child welfare 

workers and to retain those already in the field. For example, 

caseworkers in each of the four states we visited said that many of 

their former child welfare colleagues pursued positions in the 

education field where they could not only make more money but also work 

with children without risking their own safety. Disparities in the 

salaries between public and private child welfare workers--with public 

agency caseworkers generally earning higher salaries--also present a 

retention challenge within the child welfare profession. Additionally, 

high caseloads, administrative burdens, limited supervision, and 

insufficient training reduce the appeal of child welfare work. 

Caseworkers and supervisors in all four states cited demanding and 

complex caseloads and related administrative requirements, such as 

casework documentation, as factors affecting retention. Some of the 

caseworkers we interviewed handle double the number of cases 

recommended by advocacy organizations and spend between 50 and 80 

percent of their time completing paperwork, thereby limiting their time 

to assist children and families. Caseworkers told us that their desire 

to stay in the child welfare profession was influenced by high-quality 

supervision and adequate on-the-job training; however, these elements 

were often lacking. Some newly promoted supervisors, in particular, 

have said that they feel unprepared to meet job demands. Most of these 

issues also surfaced in our review of exit interview documents, 

although many workers indicated that they were leaving their positions 

for reasons not directly related to the workplace, such as to retire, 

stay at home with young children, or return to school.



Some evidence suggests how recruitment and retention challenges affect 

children’s safety and permanency. Caseworkers in the four states that 

we visited said that high turnover rates and staffing shortages leave 

remaining staff with insufficient time to conduct the types of home 

visits necessary to assess children’s safety and to make well-supported 

decisions to ensure safe and stable permanent placements. Worker 

turnover also disrupts the continuity of services, particularly when 

newly assigned caseworkers have to conduct or reevaluate educational, 

health, and safety assessments due to poor or insufficient information 

in case files left behind by others. Our analysis of federal CFSRs 

corroborated caseworker accounts, showing that large caseloads and 

worker turnover delay the timeliness of investigations and limit the 

frequency of worker visits with children, thereby hampering agencies’ 

attainment of some key federal safety and permanency goals. HHS 

officials said that they plan to examine these reviews to better 

understand the relationship between recruitment and retention and 

safety and permanency outcomes across the states. HHS currently has not 

targeted retention and recruitment as priority issues, however, because 

the federal government has no requirements concerning staffing and case 

management, and states have made few requests of HHS’s national 

resource centers for assistance with child welfare staff recruitment 

and retention.



Child welfare agencies have implemented various workforce practices--

including training partnerships, accreditation, and enhanced 

supervision--to improve recruitment and retention, but few of these 

initiatives have been fully evaluated. Dozens of state agencies have 

used federal and state training dollars to form partnerships with 

universities and their schools of social work to train current 

caseworkers and better prepare social work students to enter the child 

welfare profession. In exchange for tuition stipends, the students who 

participate in these programs commit to work in a public child welfare 

agency for a minimum specified term, typically 1 to 2 years. In 

Kentucky and California, studies showed that 86 and 

85 percent, respectively, of participants continued to work for the 

agency after their minimum work commitment concluded. In Kentucky, this 

retention rate far exceeded the percentage of nonparticipants who 

remained with the agency over the same period. Accreditation can also 

enhance recruitment and retention. Illinois officials told us that 

meeting accreditation standards of lower caseloads, reduced supervisor-

to-staff ratios, and increased emphasis on professional credentials has 

improved the agency’s attractiveness to applicants and enhanced worker 

morale and performance--two factors critical to retention. 

Additionally, programs that improve supervision through leadership 

development and specific mentoring relationships appear to aid in staff 

decision making and reduce staff’s case management related stress. 

Other potentially promising practices include recruitment bonuses and 

opportunities for applicants to preview jobs by viewing videotapes of 

caseworkers performing their duties. In this way, caseworkers were 

reported to have a clearer understanding of the job’s requirements 

before they accepted employment and appeared to be less intimidated by 

the job’s challenges once employed.



Given the reported impact of staffing shortages and high caseloads on 

the attainment of federal outcome measures, we are recommending that 

the Secretary of HHS take actions that may help child welfare agencies 

address the recruitment and retention challenges they face. In 

commenting on a draft of this report, the Administration for Children 

and Families (ACF) generally agreed with our findings and 

recommendation. ACF noted that it has begun to explore the 

effectiveness of child welfare training programs, with an emphasis on 

lessons learned and best practices. However, ACF also noted constraints 

that it believes affect its ability to further assist the states. We 

believe that ACF’s stated actions represent a first step and, as we 

recommended, that it should take additional actions to help child 

welfare agencies address other facets of their recruitment and 

retention challenges.



Background:



Most states and counties provide some child welfare services directly 

and provide others through contracts with private agencies, where 

caseworkers provide residential treatment and family support services 

as well as reunification and adoption services. The role and level of 

assistance that private child welfare agencies provide varies by state, 

though in Illinois for example, approximately 80 percent of child 

welfare services is reported to be provided through the private sector. 

Although public and private child welfare agencies face different 

financial constraints and use different personnel guidelines, national 

survey data confirm that both state and private child welfare agencies 

are experiencing similar challenges recruiting and retaining qualified 

caseworkers. For instance, turnover of child welfare staff--which 

affects both recruitment and retention efforts--has been estimated at 

between 

30 percent and 40 percent annually nationwide, with the average tenure 

for child welfare workers being less than 2 years.



Evidence from a national child welfare workforce study indicates that 

fewer than 15 percent of child welfare agencies require caseworkers to 

hold either bachelors or masters degrees in social work,[Footnote 5] 

despite several studies finding that Bachelor’s of Social Work (BSW) 

and Master’s of Social Work (MSW) degrees correlate with higher job 

performance and lower turnover rates among caseworkers.[Footnote 6] 

Further evidence suggests that the majority of credentialed social 

workers are not employed in child or family service professions; 

instead, they choose professions in mental health, substance abuse 

prevention, rehabilitation, and gerontology.



Nevertheless, child welfare caseworkers, assisted by their supervisors, 

are at the core of the child welfare system, investigating reports of 

abuse and neglect; coordinating substance abuse, mental health, or 

supplemental services to keep families intact and prevent the need for 

foster care; and arranging permanent or adoptive placements when 

children must be removed from their homes. In some agencies, 

caseworkers perform multiple functions from intake to placement on any 

given case; in others, they are specialized in areas such as 

investigations, reunification/family preservation, and adoptions. The 

primary role of supervisors is to help caseworkers perform these 

functions, thereby meeting the needs of families and carrying out the 

agency’s mission. Some functions of the child welfare supervisor 

include assigning cases, monitoring caseworkers’ progress in achieving 

desired outcomes, providing feedback to caseworkers in order to help 

develop their skills, supporting the emotional needs of caseworkers, 

analyzing and addressing problems, and making decisions about cases. In 

addition, given the challenges agencies face in recruiting and 

retaining child welfare workers, some supervisors provide direct 

assistance to caseworkers by taking on some of their cases.



The federal government’s primary connection to the child welfare 

workforce has been through its funding of child welfare training 

programs as they relate to the provision of child welfare services. ACF 

at HHS is responsible for the administration and oversight of the 

approximately 

$7 billion in federal funding allocated to states for child welfare 

services. As part of this allocation, ACF provides matching funds for 

the training and development of child welfare caseworkers through Title 

IV-E of the Social Security Act. Title IV-E authorizes partial federal 

reimbursement[Footnote 7]--75 percent--of states’ training funds to 

implement training programs for current child welfare staff and to 

enhance the child welfare curriculum of undergraduate and graduate 

social work programs to better educate and prepare potential 

caseworkers. This funding may also be used for curriculum development, 

materials and books, support for current workers to obtain a social 

work degree, and incentives to induce entry to the child welfare field. 

During fiscal year 2001, 49 states received 

$276 million in Title IV-E training reimbursements.[Footnote 8] These 

reimbursements ranged from a low of approximately $1,400 in Wyoming to 

a high of more than $59 million in California, with the median 

reimbursement approximating $3.1 million.



In addition, ACF’s Children’s Bureau manages six discretionary grant 

programs through which it funds various activities related to 

improvements in the child welfare system. Each of these programs 

receives a separate annual appropriation from the Congress. One of 

these programs--the Child Welfare Training Program, authorized by 

Section 426 of Title IV of the Social Security Act--awards grants to 

public and private nonprofit institutions of higher learning to develop 

and improve the education, training, and resources available for child 

welfare service providers. This is the only program of the six with a 

specific emphasis on staff training;[Footnote 9] however, in fiscal 

year 2002, it received the second smallest share--9 percent--of the 

Children’s Bureau’s total discretionary funds (see fig. 1).



Figure 1: Distribution of Discretionary Grant Funds for Child Welfare 

Services:



[See PDF for image]



[End of figure]





In 2000, ACF began a new federal review system to monitor states’ 

compliance with federal child welfare laws. Under this system, ACF 

conducts CFSRs, assessing states’ performance in achieving the goals of 

safety, permanency, and child and family well-being--three goals 

emphasized in ASFA. The CFSR process involves a state self-assessment 

and an on-site review by a joint team of federal and state officials to 

assess states’ performance on assessment measures such as timely 

investigations of maltreatment and caseworker visits with 

families.[Footnote 10] States that have not met the standards are 

required to develop a program improvement plan (PIP) and can face the 

withholding of federal funds should they fail to develop a plan or fail 

to take the specified corrective actions. As of December 1, 2002, ACF 

had completed and documented its reviews for 

27 states.



In addition to these reviews, ACF provides assistance to states via its 

10 resource centers, all of which have different areas of expertise, 

such as organizational improvement, legal and judicial guidance, and 

child welfare information technology. The primary goal of these centers 

is to help states implement federal legislation intended to ensure the 

safety, well-being, and permanency of children who enter the child 

welfare system, to support statutorily mandated programs, and to 

provide services to discretionary grant recipients. These centers 

conduct needs assessments, sponsor national conference calls with 

states, collaborate with other resource centers and agencies, and 

provide on-site technical assistance and training to states. States may 

request specific assistance from the centers; however, ACF sets the 

centers’ areas of focus and priorities, and no one center focuses 

specifically on recruitment and retention issues at this time.



Figure 2 shows the major channels through which federal dollars can be 

used for staff development.



Figure 2: Major Channels of Federal Funding for Staff Development:



[See PDF for image]



[End of figure]



Members of the current and previous Congress have introduced proposals 

to expand federal funding to combat the recruitment and retention 

challenges that child welfare agencies face. As of March 26, 2003, the 

Congress was considering H.R. 14 and S. 342, each named the “Keeping 

Children and Families Safe Act of 2003,” which contain provisions to 

improve the training of supervisory and nonsupervisory workers; improve 

public education relating to the role and responsibilities of the child 

protective system; and provide procedures for improving the training, 

retention, and supervision of caseworkers.[Footnote 11] The Congress is 

also currently considering S. 409 and H.R. 734, bills that would 

provide federal loan forgiveness to social workers who work for child 

protective agencies and have obtained their bachelor’s or master’s 

degrees in social work.[Footnote 12] As a tool to increase retention, 

both of these bills tie education loan repayment to tenure, such that 

the longer the caseworker remains with the agency, the greater the 

share of the loan that is repaid. These bills would apply to 

caseworkers in public and private child welfare agencies operating 

under contract with the state.



Public and Private Child Welfare Agencies Face Challenges in Recruiting 

and Retaining Workers and Supervisors:



Child welfare agencies face a number of challenges recruiting and 

retaining workers and supervisors. Public and private agency officials 

in all four of the states we visited struggled to provide salaries 

competitive with those in comparable fields, such as teaching. 

According to these officials, they lose both current workers and 

potential hires to these fields, which pay higher wages and offer safer 

and more predictable work environments. National salary data, though 

somewhat broad in how it defines certain occupations, confirm that 

child and family caseworkers earn less than educators. Specifically, 

one county official in Texas said that teachers now earn starting 

salaries of about $37,000 while entry-level caseworkers earn about 

$28,000 annually, a difference of about 32 percent. Caseworkers we 

interviewed in each state also cited administrative burdens, such as 

increased paperwork requirements for each child in a case; a lack of 

supervisory support; and insufficient time to participate in training 

as issues impacting both their ability to work effectively and their 

decision to stay in the child welfare profession. These issues were 

mentioned by both public and private agency staff in all four states, 

where some caseworkers handled double the number of cases recommended 

by independent child welfare organizations. Former child welfare 

workers also identified these issues in exit interview documents we 

reviewed. In addition to retirement and other personal reasons staff 

chose to leave their positions, low salaries and high caseloads were 

among the factors affecting child welfare workers’ decisions to sever 

their employment.



Low Salaries Hinder Agencies’ Ability to Maintain a Stable Workforce:



Public and private agencies we visited in all four states struggled to 

provide salaries competitive with those in comparable occupations and 

encountered difficulty retaining staff due to salary gaps within the 

profession of child welfare. According to our analysis of 585 exit 

interviews completed by staff who severed their employment, 81 cited 

low pay as one of their reasons for leaving.[Footnote 13] In addition, 

according to agency officials in all four states, they consistently 

lose both current workers and potential hires to higher-paying 

professions, such as teaching.[Footnote 14] The Bureau of Labor 

Statistics’ national wages survey[Footnote 15] reports that elementary 

and middle school teachers earn, on average, about $42,000 annually 

while social workers earn about $33,000.[Footnote 16] Furthermore, one 

California private agency reported that foster care caseworkers with 

MSWs who worked in group residential care facilities, which provide 

structured living arrangements and treatment services for children with 

complex needs, earned from $5,000 to $30,000 less than school 

counselors, nurses, and medical and public health social 

workers.[Footnote 17] Other states also report significant wage 

disparities within the child welfare profession. One study in South 

Carolina found that salaries for public agency caseworkers were almost 

double those of direct care workers in private agency residential 

programs.[Footnote 18] Additionally, according to labor union 

representatives in Illinois, public agency caseworkers there earn 

considerably more than staff in private child welfare agencies, and 

union officials at the national level attribute this wage gap to their 

lobbying efforts.



In addition, low salaries--because they often contribute to limited 

applicant pools--can make it particularly difficult for agencies to 

recruit child welfare staff in certain geographical areas and to serve 

bilingual clients. For example, a New York State study of turnover 

among caseworkers from January to December 2001 shows that small 

counties near cities, in particular, have more difficulty recruiting 

staff because of higher salaries in surrounding areas.[Footnote 19] 

Additionally, in Texas for example, officials said that counties in 

rural areas with larger Spanish-speaking and Native American 

populations do not pay adequate salaries to successfully recruit 

qualified bilingual staff or staff who are sensitive to local cultures. 

State officials in Illinois and California echoed these concerns.



Furthermore, according to public agency caseworkers in Texas, their 

salaries do not reflect the risks to personal safety they face as part 

of their work. These caseworkers told us that given the safety risks 

they are exposed to daily, they should be given hazardous duty pay 

similar to workers in other high-risk professions. According to a 

national study by the American Federation of State, County, and 

Municipal Employees (AFSCME),[Footnote 20] a union representing 

primarily government employees including child welfare caseworkers 

throughout the country, caseworkers routinely deal with high levels of 

risk. Specifically, AFSCME researchers found that more than 70 percent 

of front-line caseworkers had been victims of violence or threats of 

violence in the line of duty. In addition, in a peer exit interview 

process conducted in one state we visited, 90 percent of its child 

protective services employees reported that they had experienced verbal 

threats; 30 percent experienced physical attacks; and 13 percent were 

threatened with weapons.



High Caseloads, Administrative Burdens, Limited Supervision, and 

Insufficient Training Reduce the Appeal of Child Welfare Work:



Although many of the caseworkers and supervisors we interviewed in each 

state told us they were motivated by their desire to help people, 

protect children, work with families, and potentially save lives, they 

also told us that workplace issues such as high caseloads, 

administrative burdens, limited supervision, and insufficient time to 

participate in training reduce the appeal of child welfare work, making 

it difficult for staff to stay in their positions. In each of the four 

states we visited, the agency’s inability to retain staff has 

contributed to existing unmanageable caseloads. CWLA suggests a 

caseload ratio of 12 to 15 children per caseworker, and COA suggests 

that caseloads not exceed 18 children per caseworker. However, in its 

May 2001 report, the American Public Human Services Association (APHSA) 

reported that caseloads for individual child welfare workers ranged 

from 10 to 110 children,[Footnote 21] with workers handling an average 

of about 24 to 31 children each (see fig. 3). Managers we interviewed 

in California confirmed this, stating that caseworkers often handle 

double the recommended number of cases.



Figure 3: Comparison of Average and Individual Child Welfare Worker 

Caseloads to Recommended Standards:



[See PDF for image]



Note: Cases are defined as one child. Not all open cases are actively 

managed. According to a CWLA official, due in part to high caseloads, 

case files that should be closed sometimes will remain open.



[End of figure]



Furthermore, caseworkers and supervisors we interviewed in the four 

states we visited told us that heavy workloads encourage workers to 

leave for other careers that they perceive as requiring less time and 

energy. For instance, caseworkers in Texas told us that former co-

workers left the field to go into teaching, in part, because of the 

more appealing work schedule, including seemingly shorter hours and 

holidays and summers off. Also, caseworkers in all states we visited 

emphasized concerns about the increasing complexity of cases--more 

cases involve drug and alcohol abuse and special needs children, in 

particular. In the exit interview documents we reviewed, 86 out of 585 

child welfare workers identified high caseloads as a factor influencing 

their decision to leave. One former private agency caseworker in 

Delaware reported in an exit interview that, although caseloads were 

manageable, the complexity of each case was a problem. In addition, one 

former county worker in California said that cases are becoming 

increasingly difficult, and caseworkers are no longer able to do 

“social work.” This caseworker also said that the amount of work and 

stress is endless and limits the amount of time she has to perform her 

job well.



Furthermore, caseworkers and supervisors in the four states we visited 

told us that overwhelming administrative burdens, such as paperwork, 

take up a large portion of their time, with some estimating between 

50 percent and 80 percent. Some also said that these administrative 

burdens were factors influencing their decisions to seek other types of 

employment. According to two labor union representatives in 

California,[Footnote 22] caseworkers often have to work overtime to 

complete their paperwork, but instead of being compensated in salary 

for their overtime, they are given days off. The representatives said, 

however, that many caseworkers could not afford to take time off 

because paperwork continues to mount in their absence. Caseworkers in 

Illinois, for example, told us that they are required to complete more 

than 150 forms per child in their caseload. Such requirements are 

multiplied as caseloads increase. One study of the child welfare system 

reported that part of the administrative burden child welfare workers 

face also stems from the time they must spend in court as a result of 

requirements of ASFA.[Footnote 23] The authors said that child welfare 

workers frequently mentioned that the earlier and more frequent court 

hearings that ASFA requires mean additional responsibilities for them. 

Furthermore, in exit interview documentation we reviewed, workers 

expressed frustration with these burdens, with some saying that they 

spent insufficient amounts of time with families due to paperwork, in 

particular, and that more clerical staff is needed to assist with 

documentation. One caseworker in a California county indicated that 

more than 80 percent of her job was administrative and that it was 

impossible to meet all administrative requirements and do a quality job 

at the same time.



Officials and caseworkers in all of the states we visited also 

expressed concerns about the quality of supervision, with most 

indicating that supervisory support either motivated caseworkers to 

stay despite the stress and frustration of the job or that lack of 

supervisory support was a critical factor in their decision to leave. 

Although challenging, two critical functions of child welfare 

supervisors are to recognize and respond to the needs and concerns of 

caseworkers and to provide them with direction and guidance. However, 

caseworkers we visited said that their supervisors are often too busy 

to provide the level of supervision needed. In Kentucky, workers told 

us that the inaccessibility of their supervisors negatively impacted 

their effectiveness and morale. Furthermore, one Texas state official 

told us that because of high turnover, caseworkers with only 

3 years of experience are commonly promoted to supervisory positions. 

According to tenured supervisors there, this advanced promotion track 

has caused additional problems. Some newly promoted supervisors have 

requested demotions because they feel unprepared for the job 

requirements, and the caseworkers they supervise have complained of 

poor management and insufficient support.



Our analysis of exit interview documents revealed that inadequate 

supervision was not among the top five reasons caseworkers gave for 

leaving, but some caseworkers (about 7 percent) cited it as an area of 

concern. One former county caseworker in Pennsylvania, who had been 

with the agency for 3 years, reported that her supervisor lacked both 

leadership qualities and experience. Additionally, one private agency 

caseworker in Wisconsin, who had left the agency after just 6 months, 

reported in her exit interview that mentors were good when they were 

available, but they were often unavailable due to work demands. She 

also reported that mentorship becomes even more difficult when a group 

of new caseworkers completes training at the same time, suggesting a 

lack of tenured staff interested or available to provide such on-the-

job guidance. Furthermore, a former caseworker in Arizona reported that 

communications with her supervisor were mainly through electronic mail-

-seldom in person. Finally, a former private agency caseworker in Maine 

said that most interactions with her supervisor seemed punitive rather 

than educational or supportive in nature.



Agency and supervisory support can mitigate the stress of the job and 

the workload, according to some studies. For example, one California 

county’s workforce analysis stated that competent and supportive 

supervision was critical to reducing staff turnover.[Footnote 24] 

Another California study--in a county where most caseworkers indicated 

that they were satisfied with their jobs--reported that these 

caseworkers rated their relationship with supervisors as one of the 

most satisfying factors of their work, giving supervisors very high 

ratings for their effectiveness, personal skills, and ability to help 

workers collaborate.[Footnote 25]



In addition to their concerns about supervision, caseworkers and 

supervisors in all four states consistently told us that insufficient 

training poses a recruitment and retention challenge to their agencies. 

Specifically, they told us that training opportunities were often 

inadequate to ensure a smooth transition for new recruits into the 

agency. Despite the fact that public agencies in all four states had 

both minimum requirements for training new hires and ongoing training 

for senior workers, some caseworkers said that basic training does not 

provide new staff with the skills they need to do their jobs. 

Additionally, they told us that with high caseloads and work 

priorities, neither supervisors nor tenured staff are able to conduct 

on-the-job training to compensate. In one urban Texas region, for 

example, caseworkers told us that new hires are typically assigned 

between 40 and 60 cases within their first 3 months on the job. 

According to caseworkers there, high caseloads and the limited time new 

hires spend in training are often responsible for caseworker turnover. 

Furthermore, by their supervisors’ estimation, about half of new 

trainees leave their jobs before completing 1 year. According to these 

supervisors, many leave, in part, because they are not sufficiently 

trained and supported to do their jobs.



Participation in ongoing training for staff at all levels also appears 

problematic--caseworkers in each state told us either that available 

training did not meet their needs or that they did not have time to 

participate in classes. For example, in Illinois, caseworkers said 

training was often too time-consuming and irrelevant. They added that, 

given the administrative burdens of paperwork, they most need training 

on paperwork management. Furthermore, university Title IV-E program 

officials in Kentucky said that Title IV-E funds, which support 

caseworker training and development, cannot be used to provide courses 

specifically on substance abuse or mental health training,[Footnote 26] 

which they noted would be particularly relevant to service delivery. 

Additionally, caseworkers in all states we visited said that, when 

training was available, high caseloads and work priorities hindered 

their attendance. In Kentucky, for example, caseworkers told us that, 

unless training is required, they do not attend because casework 

accumulates, discounting the value of the training received. In 

addition, caseworkers in California said that one program designed to 

allow part-time work while they pursue an MSW is not practical because 

caseloads are not reduced and performance expectations do not change.



Challenges in training child welfare workers also exist for public 

agencies that contract with private agencies to provide services. The 

federal government reimburses states 75 percent for training public 

agency staff and 50 percent for training private agency employees. In 

Illinois, where about 80 percent of child welfare services are provided 

under contract with private agencies, training reimbursement has become 

a major issue for workforce development. One program director said that 

many workers have left private child welfare agencies in Illinois 

because they did not believe that existing training programs adequately 

prepared them to do their jobs. However, Illinois recently took steps 

towards addressing these issues by pursuing a waiver from HHS to obtain 

additional reimbursement for training expenses. According to HHS 

officials, Illinois is the only state, to date, that has requested and 

received this spending authority. From Illinois’ officials’ 

perspectives, however, states that have opted to privatize child 

welfare services should not be penalized or compelled to apply for a 

waiver in order to ensure that all service providers are adequately 

trained.



Some Evidence Suggests How Recruitment and Retention Challenges Affect 

Children’s Safety and Permanency, but the Magnitude of the Effect Is 

Unknown:



Caseworkers we interviewed in all four states and our analysis of HHS’s 

CFSRs indicate that recruitment and retention challenges affect 

children’s safety and permanency by producing staffing shortages that 

increase the workloads of remaining staff. As a result, they have less 

time to establish relationships with children and their families, 

conduct frequent and meaningful home visits in order to assess 

children’s safety, and make thoughtful and well-supported decisions 

regarding safe and stable permanent placements. Our analysis of the 27 

available CFSRs corroborates caseworkers’ experiences showing that 

staff shortages, high caseloads, and worker turnover were factors 

impeding progress toward the achievement of federal safety and 

permanency outcomes. Although HHS officials told us that they plan to 

examine these reviews to better understand the relationship between 

recruitment and retention and safety and permanency outcomes across the 

states, they have not yet completed this effort.



Agency Staff Shortages and High Caseloads Impair Caseworkers’ Abilities 

to Perform Critical Case Management Activities:



According to the caseworkers we interviewed in each of the four states, 

staffing shortages and high caseloads disrupt case management by 

limiting their ability to establish and maintain relationships with 

children and families. They told us that gathering information to 

develop and manage a child’s case requires trust between the child and 

the caseworker. Due to turnover, this trust is disrupted, making it 

more difficult for caseworkers who assume these cases to elicit from 

the child the type of information necessary to ensure appropriate care. 

For example, when staff change, caseworkers may have to reestablish 

information to update the case record, frustrating all parties 

involved. Caseworkers noted that families become hesitant to work with 

unfamiliar caseworkers, making it difficult to learn the history of the 

case. The negative effects of turnover can be particularly pronounced 

in group residential care facilities. According to several residential 

care caseworkers in California and Illinois, worker turnover compounds 

children’s feelings of neglect and often results in behavior changes 

that affect their therapeutic treatment plans. These workers said that 

children channel their feelings of abandonment towards remaining staff, 

become resistant to therapy, and act violently and aggressively towards 

other children in the residential facility.



In every state we visited, caseworkers said that staffing shortages and 

high caseloads have had detrimental effects on their abilities to make 

well-supported and timely decisions regarding children’s safety. Many 

said that high caseloads require them to limit the number and quality 

of the home visits they conduct, forcing them to focus only on the most 

serious circumstances of abuse and neglect. One caseworker in Texas 

noted that when she does make a home visit, the visit is quick and does 

not enable her to identify subtle or potential risks to the child’s 

well-being.



Other caseworkers in all four states said that when they assume 

responsibility for cases as a result of worker turnover, their own 

caseloads increase and their ability to ensure the safety of the 

children whose cases they assume is limited. For example, a Texas 

caseworker told us that, when a former colleague left the agency, he 

was assigned a case in which the initial investigation had not been 

done. According to the caseworker, because his own caseload was high 

before assuming responsibility for the new case, the investigation of 

the abuse allegation and home visit were delayed by 3 months. As a 

result of the delay, the claim could no longer be substantiated--the 

evidence of alleged abuse had healed, no one could corroborate the 

claim, and the case was closed. By his estimation, if the case 

initially had been handled more quickly, or if high caseloads were not 

driving attrition, caseworkers might be better able to identify, 

mitigate, and/or prevent future situations that could possibly 

jeopardize children’s safety.



Additionally, all of the caseworkers we interviewed told us that 

transitioning cases to remaining staff takes time and can result in 

delays or changes to permanency decisions. Caseworkers in Kentucky 

noted that this is particularly true when they assume responsibility 

for a case with inadequate documentation. Given their high caseloads 

and ASFA’s requirements to file for termination of parental rights 

(TPR) if the child has been in care 15 of the last 22 months, 

caseworkers have little time to supplement a child’s file with 

additional investigations and site visits. As a result, they sometimes 

make permanency decisions without thoroughly evaluating the adequacy 

and appropriateness of available options. According to private agency 

officials in Illinois, this type of unsupported decision making is 

believed to result in placement disruptions, foster care re-entry, or 

continued abuse and neglect. In addition, supervisors in Texas told us 

that caseworkers often determine that filing a TPR under the 15-of 22-

month provision is not in the best interests of the child when 

sufficient evidence is not available to support the TPR. In doing so, 

the caseworkers are able to continue to conduct their 

casework.[Footnote 27]



Child and Family Services Reviews Show That Workforce Deficiencies 

Hamper Agencies’ Attainment of Federal Child Welfare Outcomes:



Our examination of the 27 completed CFSRs corroborates caseworkers’ 

statements about the impact of recruitment and retention challenges on 

children’s safety, permanency, and well-being. Although identifying 

workforce deficiencies is not an objective of the CFSR process, in all 

27 CFSRs we analyzed, HHS explicitly cited workforce deficiencies--high 

caseloads, training deficiencies, and staffing shortages--that 

affected the attainment of at least one assessment measure. While the 

number of affected assessment measures varied by state, we found that 

HHS cited these factors for an average of nine assessment measures per 

state. Furthermore, more than half of the 27 states exceeded this 

average. For example, Georgia’s and Oregon’s CFSRs showed the greatest 

number of citations related to workforce deficiencies, with high 

caseloads, training deficiencies, and staffing shortages affecting the 

attainment of 14 and 16 assessment measures, respectively.



Additionally, several states’ CFSRs present useful examples of how high 

caseloads, limited training, and staffing shortages affect the outcomes 

for children and families in care. For example, in Georgia, reviewers 

found that case managers’ caseloads were unreasonably high, limiting 

their ability to conduct meaningful and frequent visits with families 

and carry out their responsibilities. Additionally, in New Mexico’s 

CFSR, reviewers cited staff turnover and vacancies as affecting 

workers’ responsiveness to cases and decreasing their ability to help 

children achieve permanency. Finally, the District of Columbia’s CFSR 

describes heavy workloads, high staff turnover, and a climate in which 

supervisors often call new workers out of training to handle ongoing 

caseload activities. Table 1 shows the assessment measures affected by 

the workforce deficiencies in five or more states.



Table 1: CFSR Assessment Measures Whose Attainment was Affected by 

Workforce Deficiencies in 5 or More of the 27 States Reviewed:



CFSR assessment measures: Caseworkers investigate reports of child 

maltreatment in accordance with state policy.; States (total 

number in parenthesis): AK, AZ, FL, GA, MA, NC, NM, OK, OR, TN, TX, VT, 

WV, (13).



CFSR assessment measures: Caseworkers maintain diligent efforts to 

provide services to families in order to protect children in home and 

prevent removal.; States (total number in parenthesis): AK, 

DE, KS, NC, NM, NY, OR, SD, TX, (9).



CFSR assessment measures: Caseworkers make diligent efforts to reduce 

the risk of harm to children in each case.; States (total 

number in parenthesis): AZ, NM, OR, TX, WV (5).



CFSR assessment measures: Caseworkers maintain stability of foster care 

placement.; States (total number in parenthesis): CT, GA, NC, 

NE, OK (5).



CFSR assessment measures: Caseworkers establish permanency goal for 

child in timely manner.; States (total number in parenthesis): 

AL, AZ, CT, DC, GA, IN, NC, NM, NY, OK, OR (11).



CFSR assessment measures: Caseworkers finalize adoptions with 

appropriate and timely efforts; States (total number in 

parenthesis): AK, AL, AZ, GA, ND, OR, TX, VT, WV (9).



CFSR assessment measures: Caseworkers assess and address the needs of 

child, parents, and foster parents adequately.; States (total 

number in parenthesis): AK, KS, ND, OR, PA, SD, WV (7).



CFSR assessment measures: Caseworkers involve children and families in 

case planning.; States (total number in parenthesis): AK, AZ, 

DE, FL, IN, KS, MN, NC (8).



CFSR assessment measures: Caseworkers adequately monitor child safety 

and well-being through frequent visits with children, focusing on case 

planning, service delivery, and goal attainment.; States 

(total number in parenthesis): AK, DC, FL, GA, IN, NC, NM, OK, OR, TX, 

VT, WV (12).



CFSR assessment measures: Caseworkers maintain sufficient face-to-face 

contact with parents to promote attainment of case goals and ensure 

children’s safety and well-being.; States (total number in 

parenthesis): DC, FL, GA, IN, NC, NE, OK, TX, VT (9).



CFSR assessment measures: Agency reduces incidence of repeat 

maltreatment.; States (total number in parenthesis): IN, KS, 

NM, NY, SD (5).



CFSR assessment measures: Agency provides a process that ensures that 

each child has a written case plan to be developed jointly with the 

child’s parent(s) that includes the required provisions.; 

States (total number in parenthesis): AK, AZ, CO, NE, OK, OR, TN, TX 

(8).



CFSR assessment measures: Agency develops and implements standards to 

ensure that children in foster care are provided quality services that 

protect the safety and health of the children.; States (total 

number in parenthesis): AK, CO, DC, KS, ND, VT (6).



CFSR assessment measures: Agency operates a staff development and 

training program that supports the goals and objectives in the Child 

and Family Services Plan[A] , addresses services provided under Titles 

IV-B and IV-E, and provides initial training for all staff who deliver 

these services.; States (total number in parenthesis): AK, AL, 

AR, AZ, CO, CT, DC, DE, FL, GA, IN, KS, MA, MN, NC, ND, NE, NM, NY, OK, 

OR, PA, SD, TN, TX VT, WV (27).



CFSR assessment measures: Agency provides ongoing training for staff 

that addresses the skills and knowledge base needed to carry out their 

duties with regard to the services included in the Child and Family 

Service Plan.; States (total number in parenthesis): AK, AR, 

AZ, CO, CT, DC, DE, FL, GA, IN, KS, MA, MN, NC, ND, NE, NM, NY, OK, OR, 

PA, SD, TN, TX VT, WV (26).



Source: GAO’s analysis of CFSR reports released before December 1, 

2002.



Note: GAO defined workforce deficiencies as one or more of the 

following: high caseloads, training deficiencies, and staffing 

shortages.



[A] Child and Family Services Plans are required under Title IV-E of 

the Social Security Act in order for states to receive federal foster 

care funds for maintenance of foster children, specific administrative 

costs associated with foster care programs, and adoption assistance.



[End of table]:



According to officials at HHS, few states have consulted the national 

resource centers for recruitment-and retention-related guidance, and 

HHS has not yet made these issues a priority in its technical 

assistance efforts. Although one center is considering studying the 

impact of recruitment and retention on federal safety outcomes, an 

action plan is not yet in place. Additionally, although HHS officials 

who participated in the CFSR process acknowledge that high caseloads 

and worker turnover can pose barriers to conformity with federal 

standards, HHS has not yet analyzed this relationship and does not 

require states to use their PIPs to address existing recruitment and 

retention challenges.[Footnote 28] While HHS has used CFSRs to identify 

best practices concerning safety and permanency planning, officials 

said the focus on states’ workforce deficiencies and their impact on 

safety and permanency outcomes has been limited. HHS attributed this 

limited focus to the absence of federal standards regarding staffing 

and case management.



Agencies Have Implemented Various Workforce Practices, but Few Have 

Been Fully Evaluated:



Public and private agencies have implemented a variety of workforce 

practices to address recruitment and retention challenges, but few of 

these initiatives have been fully evaluated. University partnerships to 

train current workers or prepare social work students for positions in 

the child welfare profession are widespread, and two of the four states 

we visited--Kentucky and California--have demonstrated several 

benefits of these programs related to recruitment and retention. 

Additionally, officials and caseworkers in Kentucky and Illinois told 

us that COA’s standards of lower caseloads, reduced supervisor-to-staff 

ratios, and increased emphasis on professional credentials have 

improved their attractiveness to applicants and enhanced worker morale 

and performance--two factors they noted were critical to retention. 

Furthermore, improvements to supervision, such as leadership 

development or mentoring programs, may help alleviate worker stress 

while other practices, such as the use of competency-based interviews 

and realistic job previews, also appear to improve agencies’ abilities 

to hire staff who are better prepared for the job’s requirements.



University-Agency Partnerships Appear to Improve Recruitment and Reduce 

Turnover:



Available evidence suggests that more than 40 state agencies have 

formed child welfare training partnerships--collaborations between 

schools of social work and public child welfare agencies--to provide 

stipends to participating students through use of federal Title IV-E 

dollars and state contributions.[Footnote 29] These programs are 

designed to prepare social work students for careers in the child 

welfare profession and develop the skills of current workers. The 

programs require that students receiving stipends for the study of 

child welfare commit to employment with the state or county public 

child welfare agency for a specified period of time. The length of the 

contractual employment obligation--usually 1 to 2 years--and the 

curriculum content each program offers differ by state and sometimes by 

university.



While few in number, authors of available studies on the impact of 

Title IV-E training partnerships suggest that they improve worker 

retention. One study tracked four cohorts of students who participated 

in a training partnership and found that overall, 93 percent continued 

to be employed in the child welfare profession--and 52 percent remained 

with public agencies--well beyond the minimum required by their 

employment obligation.[Footnote 30] Furthermore, two of the states we 

visited, Kentucky and California, conducted similar analyses of 

employee graduates of Title IV-E programs, each finding that over 80 

percent of participants remained with the state agencies after their 

initial work obligations concluded (see table 2). Kentucky state 

officials attribute these retention rates, in part, to the intensive 

coursework, formal internships, and rigorous training included in the 

curriculum of these training partnerships.



Table 2: BSW And MSW Programs Offered through Agency-University 

Partnerships in Four States:



State program: California; Key features of partnership: [Empty]; Effect 

on recruitment and retention: [Empty].



State program: California Social Work Education Center (CalSWEC) - 

Collaboration between California’s 15 graduate schools of social work, 

its Department of Social Services, county welfare directors, and the 

California chapter of the National Association of Social Workers.; Key 

features of partnership: Objective is to recruit and prepare a diverse 

group of social workers for careers in pubic service with special 

emphasis on child welfare. In exchange for full financial aid, MSW 

candidates enroll in child welfare classes, participate in fieldwork 

placements, and agree to at least 1 year of full-time employment in a 

county child welfare agency upon graduation.; Effect on recruitment and 

retention: Based on data collected in 1999 from the cohort of all 1997 

CalSWEC graduates, 85% remained with the agency after their contractual 

employment obligation was completed.[A].



State program: Illinois; Key features of partnership: [Empty]; Effect 

on recruitment and retention: [Empty].



State program: Passport Program - Collaboration between Illinois’ 13 

undergraduate schools of social work and the Department of Children and 

Family Services.; Pena Professional Degree Program--Collaboration with 

employee labor union and six graduate schools of social work to help 

staff with a demonstrated commitment to child welfare and leadership in 

the agency obtain their MSW.; Key features of partnership: Objective is 

to improve recruitment, preparation, and retention of new hires. 

Interested BSW candidates in their senior year receive full tuition in 

exchange for committing 1 year of employment to the child welfare 

agency upon graduation.; Illinois pays qualifying workers’ tuitions and 

provides paid time off to attend daytime classes. Participants sign a 

payback agreement corresponding to the level of benefits they receive. 

Selection is based on a review of a candidate’s application and 

concurrence with eligibility criteria. Receipt of the MSW is tied to an 

automatic pay increase and promotion.; Effect on recruitment and 

retention: The first cohort of Passport participants entered the 

program in August 2001. The agency’s goal is that 80% of participants 

will be retained with the agency for at least 3 years. No formal 

retention studies of either program have been conducted yet..



State program: Kentucky; Key features of partnership: [Empty]; Effect 

on recruitment and retention: [Empty].



State program: Public Child Welfare Certification Program - 

Collaboration between nine of Kentucky’s undergraduate social work 

schools and the Cabinet for Families and Children.; Key features of 

partnership: Objective is to provide advanced knowledge and skill 

preparation for undergraduate social work students entering the public 

child welfare arena. In exchange for full financial aid during their 

last 2 years in college, BSW candidates enroll in child welfare 

classes, participate in fieldwork placements, and special retreats, and 

agree to 2 years of full-time employment with the child welfare agency 

upon graduation. The program uses common instructors, syllabi, and 

texts.; Effect on recruitment and retention: A recent tracking study of 

the first cohort of certification graduates found that 86% remained 

with the agency beyond their contractual obligation,[B] while only 54% 

of nonparticipants were retained..



State program: Texas; Key features of partnership: [Empty]; Effect on 

recruitment and retention: [Empty].



State program: Throughout Texas, six universities offer both BSW and 

MSW stipends; five offer BSW stipends only; and one offers only MSW 

stipends. Title IV-E contracts are managed separately at the regional, 

rather than state level.; Key features of partnership: BSW and MSW 

students participate in field placements with the state’s child welfare 

agency and commit to a minimum of 1 year of full-time agency employment 

upon graduation. Stipends also can be awarded to current staff--who 

take courses part -time while working--for a maximum of 4 years.; 

Effect on recruitment and retention: Graduates of one participating 

Texas IV-E program were surveyed. 70% of respondents were still 

employed with the agency after their contractual employment obligation 

expired.[C].



Source: GAO’s analysis.



[A] Dickinson, Nancy S., and Robin Perry. “Do MSW Graduates Stay in 

Public Child Welfare? Factors Influencing the Burnout and Retention 

Rates of Specially Educated Child Welfare Workers.” The California 

Social Work Education Center. University of California at Berkeley, 

August 1998. A new wave of the CalSWEC retention study began in August 

2001 and data are still being analyzed.



[B] Barbee, A.P. “Creating a Chain of Evidence for the Effectiveness of 

Kentucky’s Training System.” For the CFSR. March 2003.



[C] Scannapieco, Maria and Kelli Connell-Carrick. “Do Collaborations 

with Schools of Social Work Make a Difference for the Field of Child 

Welfare? Practice, Retention, and Curriculum.” Journal of Human 

Behavior in the Social Environment. 2003.



[End of table]:



Evaluations in Kentucky and California also suggest that training 

partnerships improved worker competence. In both states, evaluations 

found that staff hired through specially designed IV-E child welfare 

programs performed better on the job and applied their training more 

deftly than employees hired through other means. In their evaluation of 

Kentucky’s training partnership program, researchers tested all new 

hires--those who had completed the program and those who did not--after 

the agency’s core competency training. Controlling for undergraduate 

grade point averages, the study found that those who completed the 

training scored better on the agency’s test of core 

competencies.[Footnote 31] Additionally, Kentucky supervisors, when 

surveyed, reported that they considered certification students to be 

better prepared for their job than other new employees. The California 

study also compared training partnership participants with 

nonparticipants and found similar results. Those who participated in 

training partnerships scored higher on a test of child welfare 

knowledge and reported greater competency in their work and a more 

realistic view of child welfare work than those who had not 

participated.[Footnote 32]



These studies and our discussion with caseworkers in all four states 

suggest that while training partnerships may increase workers’ skill 

levels, caseworkers may still feel unprepared for the realities of 

child welfare practice. The California study cited earlier found that 

IV-E graduates did not have higher levels of job satisfaction or lower 

levels of stress than their non-IV-E counterparts, and caseworkers who 

graduated from the Kentucky certification program told us that even 

with the training, they still felt unprepared to manage complex cases 

and were constantly frustrated with the burdens of paperwork 

documentation.



Systemic Improvements in Managing Child Welfare Cases Help Alleviate 

Worker Stress:



Systemic improvements in managing child welfare, such as accreditation 

and the enhancement of supervisor skills, help alleviate worker stress 

by improving the working environment. According to state officials and 

CWLA staff, accreditation facilitates high-quality service delivery, in 

part, because it requires reasonable caseloads and reduces the number 

of staff supervisors must oversee. Additionally, caseworkers and their 

managers told us that supervisory training that focuses on leadership 

skills and case management practices improves overall communication and 

aids in staff decision making.



Accreditation:



Since 1977, the Council on Accreditation for Children and Family 

Services has accredited public and private child welfare agencies that 

comply with organizational, management, and service standards of child, 

family, and behavioral healthcare services.[Footnote 33] Only two 

states--Illinois and Kentucky--have fully accredited child welfare 

systems,[Footnote 34] and caseworkers in Illinois and Kentucky told us 

that adhering to these standards--in particular, those related to 

caseloads and supervision--has improved their attractiveness to 

applicants and enhanced worker morale and performance, two factors they 

noted were critical to retention. COA’s specific standards related to 

maximum caseload size, supervisor-to-staff ratios, and professional 

credentials for caseworkers and supervisors are shown in appendix II.



According to state officials in both Illinois and Kentucky, 

accreditation has improved retention and helped their agencies better 

focus on children’s outcomes. Illinois’ Department of Children and 

Family Services received its accreditation in June 2000. Since that 

time, all private agencies that contract with the state agency are 

reported to have also received accreditation. According to the state’s 

child welfare director, the pursuit of accreditation stemmed from a 

court order mandating smaller caseloads for staff and the fact that the 

agency was confronting receivership and facing increased media 

scrutiny.[Footnote 35] According to several Illinois supervisors, 

accreditation changed the operations of the agency--they now operate 

with reduced caseloads, improved internal communication, and increased 

public confidence in the system. Furthermore, to prepare for 

reaccreditation, staff engage in a routine practice called “peer 

review” to determine how their caseload management contributes to the 

state’s safety and permanency outcomes measures. According to one 

Illinois supervisor, preparing for these peer reviews has united staff 

in a common goal and increased their attentiveness to service delivery.



Kentucky’s Cabinet for Families and Children became accredited in 

October 2002 and state officials there said that accreditation has 

helped the agency professionalize child welfare staff by emphasizing 

appropriate educational backgrounds, improving training, and building 

pride within the organization. These officials also said that 

accreditation has strengthened recruitment and improved retention 

because the agency is focused on hiring qualified people who know what 

to expect on the job. According to Kentucky supervisors and staff, 

accreditation was also the driving force behind the creation of the 

agency’s new MSW stipend program, its push towards continuous service 

quality improvement for children and families, and higher expectations 

for staff performance.



To obtain these benefits, accreditation requires sustained financial 

and organizational commitment. Even before applying, agencies devote 

significant dollars to make their services and practices compliant with 

COA eligibility standards. This process can entail reforming personnel 

policies, hiring more staff, or upgrading communication and data 

systems. Furthermore, the costs associated with 4-year accreditation 

can range from $5,700 to more than $500,000, depending on an agency’s 

annual budget. Once accredited, filling vacancies to maintain rigorous 

caseload standards, for example, becomes a constant and expensive 

demand on agencies’ resources. According to an HHS Inspector General 

report on the topic,[Footnote 36] while many agencies that receive 

accreditation may be performing well already, accreditation status does 

not guarantee high-quality service.[Footnote 37] Caseworkers in 

Illinois and Kentucky also mentioned this, telling us that they 

continue to cut corners by limiting home visits or falling behind on 

their documentation in order to manage both the volume and the 

complexity of their caseloads. Furthermore, some agencies’ staffing 

shortages are so severe that implementing COA’s educational 

requirements might further restrict the pool of qualified applicants. 

In some cases, personnel standards, such as minimum degree 

requirements, may conflict with states’ merit systems, particularly 

those that govern personnel policies and procedures. Unlike Illinois 

and Kentucky, which were able to revise their position classifications, 

other states may not be able or interested in complying with this 

standard. According to a state official in Texas, the state’s child 

welfare agency has no plans to pursue accreditation because caseloads-

-though recently reduced--are still well above COA’s standard, and the 

agency is currently struggling with staff turnover and high vacancy 

rates.



Enhancements to Supervision and Mentoring:



States have taken a number of approaches to enhance staff supervision. 

In Illinois, all supervisors are required to have an MSW, not only 

because COA requires it, but also because state officials believe the 

degree improves managers’ competencies and knowledge. Kentucky is also 

moving toward requiring MSWs of supervisors for the same reasons. 

Currently, Kentucky prefers that caseworkers have a minimum of 5 years’ 

experience before they can be promoted to supervisory positions. 

Kentucky also has a supervisory development training series that 

includes topics such as conflict resolution and supervisory skill 

mastery. Similarly, Texas offers tenured managers courses in decision 

making, program administration, and leadership. By late 2003, the 

agency plans to have these managers serving as mentors and leadership 

coaches for its new supervisors.



Kentucky has also taken steps to enhance the mentoring of new 

caseworkers. A pilot program--designed for new hires that have not 

participated in the undergraduate IV-E funded child welfare 

certification program--affords new caseworkers, for their first 3 

months on the job, the opportunity to observe and practice newly 

acquired skills under the tutelage of tenured employees selected for 

their superior performance in the agency. While an initial assessment 

of the program indicated that employees’ confidence in their skills 

improved, additional improvements are underway and must be completed 

before the program will be implemented across the state.



Use of Hiring Competencies, Realistic Job Previews and Recruitment 

Bonuses May Enhance Agencies’ Abilities to Hire Qualified Staff:



To avoid hiring decisions that may later result in turnover or poor 

performance, some agencies have begun to develop hiring competencies, 

use more realistic portrayals of an agency’s mission, and offer 

recruitment bonuses. While some evidence exists that these practices 

improve recruitment and retention, few evaluations of their success 

have been conducted.



Matching Recruits’ Competencies and Expectations with Agency Needs:



Many states have created lists of desired worker competencies to 

evaluate the skills of potential hires and match their expectations 

with agency needs. The objective of these tools is to select candidates 

who may be satisfied with and successful in the agency once 

employed.[Footnote 38] Although Illinois requires certain academic 

credentials of all new hires, the state also uses an applicant 

screening tool to assess the education, writing ability, verbal 

ability, cultural sensitivity, and ethics and judgment of candidates. 

The screening requires candidates to complete several verbal or written 

vignettes that represent realistic situations a child welfare 

investigator or caseworker might encounter. Candidates are graded on 

how they resolve situations as well as on technical skills, such as 

writing and verbal ability. Additionally, recruiters in other states, 

such as Colorado, Maine, Nebraska, and Wisconsin, require candidates to 

demonstrate the required competencies in oral and written 

communication, and explain how their interests, strengths, and academic 

credentials or experiences fit with child welfare work. Furthermore, 

Delaware’s child welfare agency and one county in Texas are attempting 

to maintain new hire pools--reserves of newly hired and trained 

caseworkers--in order to fill vacancies quickly with competent and 

well-prepared staff.



Agencies have also begun to use “realistic job previews”--videos that 

portray caseworkers confronting hostile families, working with the 

courts, and learning agency practices and protocols. Nebraska’s child 

welfare agency developed a 25-minute realistic job preview video, which 

is required viewing before any child welfare applicant can even 

schedule an interview with agency officials. This video--similar to 

ones that are used in some parts of Texas and California--describes the 

requirements of maintaining accurate records and tracking children and 

families’ progress. The video also portrays the camaraderie caseworkers 

and supervisors may share and documents the emotions caseworkers felt 

when actions on their cases were either taken or delayed. Furthermore, 

when piloting its use, researchers in Nebraska found that the realistic 

job preview prompted ill-suited applicants to self-select out of job 

competition, allowing the agency to focus its recruitment efforts on 

the most eager and informed job candidates.



Using Bonuses to Attract and Retain Caseworkers:



Another recruitment and retention practice that appears to help child 

welfare agencies hire competent staff has been the use of hiring or 

signing bonuses. Although some child welfare agencies choose instead to 

work towards more permanent increases in annual compensation packages, 

child welfare officials in Riverside County, California, who have 

implemented this practice perceive it as a necessary tool to fill their 

growing number of vacancies. Furthermore, fields comparable to child 

welfare, such as nursing--a profession in which an estimated 

120,000 positions went unfilled last year--and teaching, have used 

hiring bonuses in an attempt to reduce their labor shortages. Last 

year, according to one study,[Footnote 39] 19 states and the District 

of Columbia offered incentive programs, such as signing bonuses, to 

relieve teaching shortages. In Riverside County, the social services 

department began offering a hiring bonus in June 2000. New hires for 

one difficult-to-fill caseworker position, which requires an MSW, are 

currently offered $500 upon hiring, $500 after 6 months, and another 

$1,000 after 1 year of service. An additional 

$2,000 is granted annually to these hires until they reach their fifth 

year of employment with the agency.



Little evidence exists across occupations to determine whether or not 

incentive programs, such as bonuses, actually work to recruit and 

retain employees. In Riverside County, human resource managers said 

that they credit the monetary incentive with improving their ability to 

hire more qualified workers, reduce turnover, and improve service to 

clients. The county has not determined, however, what percentage of 

those hired under the bonus plan have remained with the agency after 2 

years on the job. Furthermore, Riverside has not done any studies to 

isolate the impact of the bonus on employees’ decisions to stay.



Conclusion:



Available evidence suggests that public and private child welfare 

agencies are experiencing difficulty hiring, training, and retaining 

their workforces. The absence of a stable, skilled, and attentive 

workforce threatens these agencies’ ability to provide services for the 

more than 800,000 children estimated to spend some time in foster care 

each year. For example, when staff shortages lead to additional 

casework that delays decision-making, states have taken advantage of 

the ASFA exemptions to the 15-of 22-month provision intended to move 

children more quickly into permanent homes. While interviews with child 

welfare workers in four states and our examination of CFSRs indicate 

that workforce issues impair agencies’ abilities to meet children’s 

needs, several workforce practices do appear to improve recruitment and 

retention. HHS’s role in identifying and addressing the challenges 

agencies face, however, has been limited. For example, HHS has not yet 

prioritized its research agenda to identify and/or assess promising 

workforce practices. Additionally, it has not provided targeted 

assistance to states to ensure that their PIPs adequately address the 

caseload, training, and staffing issues cited in the CFSR process. 

Engaging in such activities could enhance states’ capacities to improve 

their performance on safety and permanency assessment measures, 

resulting in improved outcomes for children.



Recommendation:



Because of the reported impact staffing shortages and high caseloads 

have on the attainment of federal outcome measures, we recommend that 

the Secretary of HHS take actions that may help child welfare agencies 

address the recruitment and retention challenges they face. Such 

efforts may include HHS (1) using its annual discretionary grant 

program to promote targeted research on the effectiveness of perceived 

promising practices and/or (2) issuing guidance or providing technical 

assistance to encourage states to use their program improvement plans 

to address the caseload, training, and staffing issues cited in the 

CFSR process.



Agency Comments:



We obtained comments on a draft of this report from HHS’s 

Administration for Children and Families. These comments are reproduced 

in appendix III. ACF also provided technical clarifications, which we 

incorporated when appropriate.



ACF generally agreed with our findings and said that our report 

highlights many of the concerns that the department identified in its 

analysis of the 32 Child and Family Services Reviews completed to date. 

Specifically, ACF noted that a direct relationship was found between 

the consistency and quality of caseworker visits with children and 

families and the achievement of case outcomes evaluated in the reviews. 

ACF also confirmed that high caseloads are a major factor in staff 

turnover for those states in which a review was completed. ACF also 

concurred with our recommendation, saying that it has begun to explore 

the effectiveness of child welfare training programs, with an emphasis 

on lessons learned and best practices. However, ACF stressed that it 

has no authority to require states to address caseload issues in their 

program improvement plans or to enforce any caseload standard. Further, 

although ACF agreed that high caseloads also impact the ability of 

child welfare agencies to help families achieve positive outcomes, it 

said that the federal government has limited resources to assist states 

in the area of staff recruitment and retention and noted that technical 

assistance offered by the 10 resource centers is focused specifically 

on those areas, such as permanency timeframes, where federal 

legislative or regulatory requirements exist that states must achieve. 

We believe that ACF’s stated actions represent a first step and, as we 

recommended, that it should take additional actions to help child 

welfare agencies address other facets of their recruitment and 

retention challenges.



We also provided a copy of our draft report to child welfare officials 

in the four states we visited--California, Illinois, Kentucky, and 

Texas. Each of these states generally agreed with our findings and 

provided various technical comments, which we also incorporated when 

appropriate.



We are sending copies of this report to the Secretary of Health and 

Human Services, state child welfare directors, and other interested 

parties. We will make copies available to others on request. If you or 

your staff have any questions or wish to discuss this material further, 

please call me at (202) 512-8403 or Diana Pietrowiak at (202) 512-6239. 

Key contributors to this report are listed in appendix IV. This report 

is available at no charge on GAO’s Web site at http://www.gao.gov.



Cornelia M. Ashby, Director

Education, Workforce and Income Security Issues:



Signed by Cornelia M. Ashby:



[End of section]



Appendix I: Scope and Methodology:



In order to characterize the reasons for employee turnover, we engaged 

in the first known national attempt to obtain and classify exit 

interview documents from former child welfare caseworkers and 

supervisors. To begin this analysis, we designed a survey to learn (1) 

how many agencies were conducting and documenting exit interviews with 

staff who severed their employment and (2) if these agencies would be 

willing to share these documents with us. We distributed the survey to 

the directors of all 

40 state-administered child welfare agencies (including the District of 

Columbia) and to a state-stratified sample of directors from 444 county 

child welfare agencies[Footnote 40] in each of 10 county-administered 

states.[Footnote 41] In addition, we sent our survey to a random sample 

of 281 private child welfare agencies from a universe of 945 with Child 

Welfare League of America (CWLA) membership. Responses to this survey 

indicated that 

18 states, 39 counties, and 51 private agencies were conducting, 

documenting, and willing to share the exit interviews of staff who 

severed their employment between January 1 and May 31, 2002.[Footnote 

42] After follow up, we obtained and analyzed a total of 585 exit 

interview documents from 

17 states, 40 counties, and 19 private child welfare agencies across 

the country.[Footnote 43] In addition, we received and reviewed summary 

reports--in lieu of or to supplement actual exit interview documents--

from 5 states and 

7 counties. Because of the low number of responses, we were unable to 

generalize the results of our analysis beyond the data actually 

received.



In addition to the exit interview analysis, we conducted interviews 

with about 50 child welfare practitioners and researchers to determine 

which states were experiencing recruitment and retention challenges and 

how these were being addressed. We obtained and reviewed relevant 

literature and selected four states in which to conduct comprehensive 

site visits--California, Illinois, Kentucky, and Texas. We chose these 

states in part due to their geographic diversity, the variation in 

their caseload sizes, and their abilities to provide both urban and 

rural perspectives on the issues. These states also varied in terms of 

two important characteristics of child welfare programs--county versus 

state administration and reliance on private agencies for the delivery 

of services. In each state, we interviewed management, current 

caseworkers, and supervisors at various private and public agencies; 

obtained and reviewed relevant agency documents and data on vacancy, 

turnover, salary, and caseload rates; and talked with appropriate child 

welfare associations, advocacy groups, and researchers.



To determine the extent to which recruitment and retention challenges 

affect children’s safety, permanency, and well-being, we analyzed the 

27 Child and Family Services Reviews (CFSRs) that the Department of 

Health and Human Services (HHS) had completed and released to us by 

December 1, 2002.[Footnote 44] Specifically, we conducted a content 

analysis, noting each instance in which HHS explicitly cited high 

caseloads, insufficient training, and staffing shortages as affecting 

the attainment of all 45 CFSR assessment measures. In addition to the 

CFSR analysis, we obtained evidence on the link between recruitment and 

retention challenges and outcomes from conversations with caseworkers 

and managers during our site visits and from available research on the 

topic obtained through consultation with researchers and practitioners.



To determine the workforce practices public and private agencies have 

implemented to confront recruitment and retention challenges, we relied 

on site visits to the four states, interviews with experts and 

researchers, and relevant studies that highlighted those strategies 

with promise. We were not able to conclusively determine whether such 

strategies were or will be successful, because most agencies did not 

conduct research that could isolate the effect of the practices we 

investigated.



We conducted our work between March 2002 and January 2003 in accordance 

with generally accepted government auditing standards.



[End of section]



Appendix II: Selected Council on Accreditation for Children and Family 

Services Standards:



Table 3: Staff Qualifications:



Service area: Child Protective Services; Standard: At a minimum, 

personnel assigned to the child protective service have (a) a master’s 

degree in social work or a comparable human service field from an 

accredited institution and 2 years of direct practice experience or (b) 

a bachelor’s degree in social work or a comparable human service field 

and supervision by a person with a master’s degree in social work or a 

comparable human service field who has 2 years of experience in the 

delivery of child protective services..



Service area: Adoption Services; Standard: Direct service personnel are 

qualified according to the following criteria:; (a) previous experience 

in providing adoption services or family and children services, (b) a 

bachelor’s degree from an accredited program of social work education, 

or (c) a bachelor’s degree in another human service field. COA 

Interpretation (S14.10.02):; Recently hired direct service providers 

who do not have prior experience in adoption receive 10 or more hours 

of in-service adoption training per year..



Service area: Foster and Kinship Care Services; Standard: Family foster 

care and kinship care workers have (a) an advanced degree from an 

accredited program of social work education or a comparable human 

service field or (b) a bachelor’s degree in social work or a related 

human service field, with supervision by a person with an advanced 

degree in social work or a comparable human service field who has at 

least 2 years’ experience in services to families and children.; The 

kinship care service is staffed according to the following: (a) kinship 

care workers have a bachelor’s in social work or another related human 

service field and (b) supervisors possess an advanced degree from an 

accredited program of social work education or another comparable human 

service field and have experience working with families and children..



Service area: Residential Treatment; Standard: Residential counselors 

and/or child care workers have (a) a bachelor’s degree (If a few 

extensively experienced and highly trained persons lack a bachelor’s 

degree and/or are in the process of obtaining the degree, their 

training and experience is thoroughly documented.); (b) the personal 

characteristics and experience to provide appropriate care to 

residents, win their respect, guide them in their development, manage a 

home effectively, and participate in the overall treatment program; (c) 

the temperament to work with and care for children, youth, or adults 

with special needs, as appropriate; and (d) basic skills in first-aid 

and the identification of medical needs..



Service area: Family-Centered Casework: Intensive Family Preservation; 

Standard: Direct service providers/practitioners are qualified by (a) 

an advanced degree in social work or a comparable human service field 

from an accredited institution and at least 2 years’ experience in 

family and children’s services and/or (b) a bachelor’s degree in social 

work or another human service field from an accredited institution and 

at least 3 years’ post-degree experience in family and children’s 

services. COA Interpretation (S20.7.02):; It is common for an 

interdisciplinary team to work collaboratively with families. This team 

may be comprised of individuals from the following fields: social work, 

mental health, special education, health (including nursing and public 

health), and juvenile justice. Examples of acceptable exceptions, if 

they represent a small percentage of the whole, include a BSW with only 

2 years of post-degree experience or an MSW with experience in another 

area of practice not directly applicable to family centered services..



Source: Council on Accreditation Standards and Self Study Manual, 7th 

Edition, 2001.



[End of table]



Table 4: Supervisor Qualifications:



Service area: Child Protective Services; Standard: Supervisors hold an 

advanced degree from an accredited social work program or a comparable 

human service field and have had at least 

2 years of direct practice experience in services to families and 

children..



Service area: Adoption Services; Standard: Supervisory personnel have 

prior professional experience in providing family and children’s 

services and have an advanced degree from an accredited program of 

social work education or an accredited program in another human service 

field..



Service area: Foster and Kinship Care Services; Standard: Foster/

kinship care supervisors possess an advanced degree from an accredited 

program of social work education or a comparable human service field 

and 2 years of direct practice experience..



Service area: Family Centered Casework: Intensive Family Preservation; 

Standard: Supervisors have at least an advanced degree in social work 

or in a comparable human service field from an accredited institution 

and 

2 years’ post-master’s degree experience in the delivery of family and 

children’s services..



Source: Council on Accreditation Standards and Self Study Manual, 7th 

Edition, 2001.



[End of table]



Table 5: Caseload Limitations:



Service area: Child Protective Services; Standard: Under no 

circumstances does a child protective worker’s caseload exceed (a) 15 

cases at one time that involve intensive intervention or investigation; 

(b) 30 cases at one time that involve case coordination, continuing 

services, or follow-up; and/or (c) a proportionate mix of the above. 

COA Interpretation (S10.7.07):; A child protective service case is 

defined as a child, unless a family assessment model or equivalent is 

used. In this situation, the organization must provide average caseload 

sizes under categories (a) and (b) and a rationale..



Service area: Adoption Services; Standard: The organization structures 

its services so that adoption caseloads (a) do not exceed 

25 families per worker when counseling birth families, preparing and 

assessing adoptive applicants for infant placements, and supporting 

these families following placement; (b) do not exceed 12 children per 

worker when preparing children for adoption who are older or who have 

special needs; (c) do not exceed 15 families per worker when preparing 

and assessing adoptive applicants for the placement of children who are 

older or have special needs and providing support to these families 

following placement; and (d) are adjusted for case complexity, travel, 

and nondirect service time..



Service area: Foster and Kinship Care Services; Standard: Caseloads for 

family foster and kinship workers do not exceed 18 children, and 

workers are able to perform their functions within these guidelines.; 

Treatment foster care workers have caseloads of no more than 8 

treatment foster care children.; Kinship care caseload sizes do not 

exceed 12-15 families per worker. COA note: Reviewers may vary caseload 

limits set by rating indicators if the organization can demonstrate 

that (1) its workers do not have responsibility for a major, routine 

component of case work (i.e., planning); and (2) a time study has been 

done to adequately justify the organization’s caseload limits..



Service area: Residential Treatment; Standard: Caseloads for direct 

care personnel do not exceed 12 residents..



Service area: Family Centered Casework: Intensive Family Preservation; 

Standard: For family-centered casework programs, caseloads are 

generally limited to 12 or fewer cases per direct service provider and 

are adjusted downward according to (a) internal organizational 

procedures governing caseload size that address the relationship 

between target population needs, duration and intensity of service, the 

number of service hours needed based on the issues presented, and the 

personnel model chosen by the organization; (b). the size of teams, if 

the service is team-delivered; (c) the need for extra attention in 

high-risk families; and (d) the need for balance between families at 

beginning stages of work, families moving toward termination, and 

families presenting different levels of need.; For intensive family 

preservation programs, the organization limits caseloads to 

approximately 2 to 6 families per direct service provider or team and, 

within that range, caseloads are adjusted according to (a) internal 

organization procedures governing caseload size that address the 

relationship between target population needs, duration and intensity of 

service, the number of service hours needed based on the issues 

presented and the personnel model chosen by the organization; (b) the 

need for extra attention in cases where there is active suicidal, 

homicidal or assault behavior, failure-to-thrive or severe neglect, or 

increased degree of risk of harm to children, families, or the 

community; and (c) the need for balance between families at the 

beginning stages of work, families moving toward termination, and 

families presenting different levels of need..



Source: Council on Accreditation Standards and Self Study Manual, 7th 

Edition, 2001.



[End of table]



Table 6: Supervisor-to-Staff Ratios:



Service area: Child Protective Services; Standard: A child protective 

service supervisor is responsible for supervising no more than (a) 

seven workers who are experienced and professionally trained and/or (b) 

five workers who have less professional education and experience..



Service area: Foster and Kinship Care Services; Standard: The maximum 

supervisor to caseworker ratio is 1:5..



Service area: Family Centered Casework: Intensive Family Preservation; 

Standard: The standards for supervisory workloads are: (a) one full-

time equivalent supervisor for each of five to eight practitioners or 

teams and (b) appropriately modified for total number of families 

represented, experience levels of practitioners, geographic distances, 

size of teams, and other relevant factors..



Source: Council on Accreditation Standards and Self Study Manual, 7th 

Edition, 2001.



[End of table]



[End of section]



Appendix III: Comments from the Department of Health and Human 
Services:



DEPARTMENT OF HEALTH AND HUMAN SERVICES:



ADMINISTRATION FOR CHILDREN AND FAMILIES 

Office of the Assistant Secretary, 

Suite 600 370 L’Enfant Promenade, S.W.



Washington, D.C. 20447:



MAR 18 2003:



TO:	Cornelia M. Ashby:



Director, Education, Workforce, and Income Security Issues General 

Accounting Office:



FROM:	Wade F. Horn, Ph.D.	 Assistant Secretary:



for Children and Families:



SUBJECT: Comments on the GAO Draft Report, “HHS Could Play a Greater 

Role in Helping Child Welfare Agencies Recruit and Retain Staff,” GAO-

03-357:



Attached are the Administration for Children and Families’ comments on 

the GAO Draft Report, “HHS Could Play a Greater Role in Helping Child 

Welfare Agencies Recruit and Retain Staff, “ GAO-03-357.



Should you have questions regarding our comments, please contact Marva 

Benjamin, Child Welfare Program Specialist, Administration on Children, 

Youth and Families, at (202)205-8405.



Attachment:



COMMENTS OF THE ADMINSTRATION FOR CHILDREN AND FAMILIES ON THE GENERAL 

ACCOUNTING OFFICE’S DRAFT REPORT, “HHS COULD PLAY A GREATER ROLE IN 

HELPING CHILD WELFARE AGENCIES RECRUIT AND RETAIN STAFF” (GAO-03-357):



The Administration for Children and Families (ACF), Administration on 

Children, Youth and Families (ACYF), Children’s Bureau (CB) appreciates 

the opportunity to comment on this draft report, which addresses the 

causes, impact of, and possible solutions to staff recruitment 

challenges and turnover rates in child welfare programs.



General Comments:



This report provides a thoughtful analysis of data about and interviews 

with child welfare staff at the local and State office levels. States 

may use this information to help prioritize their efforts to develop 

and maintain an effective child welfare workforce. Further, although 

few in number, the ACF funded university and State child welfare agency 

partnerships referenced in this report have had a positive impact on 

State child welfare agencies’ ability to recruit and retain child 

welfare staff. Since States face many different caseworker recruitment 

and retention barriers, State-specific assessments are a useful way for 

them to understand current personnel practices, training programs and 

supervision in order to develop effective strategies for improvement. 

Such strategies must take into consideration the requirements of the 

Adoption and Safe Families Act (ASFA) of 1997. The principles that 

govern this Act to ensure child safety and shorten the time frame for 

making permanency decisions are the safety, permanency and well-being 

of children and their families. The Department of Health and Human 

Services (HHS) monitors State compliance with ASFA through the Child 

and Family Services Reviews (CFSRs).



ACF’s initial analysis of the CFSR data involving the first 32 States 

reviewed makes it abundantly clear that sufficient staff to make 

regular, substantive contacts with the children and families in their 

caseloads is essential. A direct relationship was found between the 

consistency and quality of caseworker visits with the child and family 

and the achievement of case outcomes evaluated in the CFSR. Although 

such a correlation has long been suspected, this is the first time that 

data provided a basis for ACF to note with confidence that consistency 

in caseworker visitation has a positive impact on achieving the Federal 

expectations set for State child welfare program performance.



Additionally, analysis of the data related to State performance in the 

CFSR found that none of the first 32 States reviewed were in 

substantial conformity with the well-being outcome that “Families have 

enhanced capacity to provide for their children’s needs.” This is 

consistent with the GAO report finding that caseworkers interviewed 

cited staffing shortages and high caseloads as factors that disrupt 

their ability to establish and maintain relationships with children and 

families. Other major factors cited are the overwhelming administrative 

burdens of paperwork requirements, and at least one study attributed 

part of the administrative burdens caseworkers face to the time they 

must spend in court as a result of ASFA requirements. However, it is 

unclear as to the extent paperwork requirements involving documentation 

of case planning with families affects efforts to prevent removals and 

achieve permanency consistent with ASFA requirements. Nevertheless, as 

noted in the GAO report, these barriers to relationship building:



hamper gathering information from each family to identify service 

needs. Logically, if service needs are not adequately identified, the 

family’s capacity to better provide for their children’s needs cannot 

be substantially improved.



GAO Recommendation:



Because of the reported impact of staffing shortages and high caseloads 

on the attainment of Federal outcome measures, GAO recommends that the 

Secretary of HHS take actions that may help child welfare agencies 

address the recruitment and retention challenges they face. Such 

efforts may include HHS (1) using its annual discretionary grant 

program to promote targeted research on the effectiveness of perceived 

promising practices and/or (2) issuing guidance or providing technical 

assistance to States to ensure that States’ program improvement plans 

adequately address the caseload, training and staffing issues cited in 

the reviews HHS conducts.



ACF Comments:



ACF concurs with GAO’s recommendation on the need for action in 

addressing staff recruitment and retention issues. Activities have been 

set in motion to explore the effectiveness of child welfare training 

programs, with an emphasis on lessons learned and best practices. ACF 

believes that there is a need to develop and implement a training model 

on recruiting and retaining a strong workforce in child welfare. A 

strong workforce includes professionally trained, front-line workers 

with desired worker competencies, as well as placing a strong emphasis 

on learning, innovation and staff development. With regard to the 

recommendation to issue guidance or provide technical assistance to 

States for ensuring that their program improvement plans (PIPs) address 

caseload, training and staffing issues, it must be stressed that HHS 

has no authority to require States to address caseload issues in their 

PIPS nor does it have authority to enforce any such caseload provision.



The Child and Family Services (CFS) reviews provide an outcomes-based 

model utilizing multiple sources of information for assessing child 

protection and child welfare services provided by the States. As part 

of the CFS review, States are required to conduct a Statewide self-

assessment to identify program strengths and barriers to performance in 

relation to Federal requirements. The systemic indicator which HHS 

monitors related to casework staff is based on Federal law and is as 

follows:



“The State is operating a staff development and training program that 

supports the goals and objectives in the Child and Family Service Plan 

(CFSP), addresses services provided under titles IV-B and IV-E, and 

provides initial training for all staff who deliver these services.”:



Although the CFS review does not include issues such as caseload size 

in its review process, it is nevertheless clear from interviewing staff 

in the 32 States that have undergone the CFS review that high caseloads 

are a major contributor to staff turnover. Such high caseloads also 

impact the ability of child welfare agencies to help families achieve 

positive outcomes.



Issues related to caseworker training and performance are noted in the 

CFS review during the on-site review of specific cases and in local and 

State-level stakeholder interviews. The additional information 

obtained during the CFS review gives the context needed to understand 

how staffing patterns, high caseload and worker retention impact case 

outcomes. Using the full information gathered in the review allows HHS 

to target technical assistance resources better to specific barriers in 

each State.



A number of States have identified strategies that target workforce 

stabilization and reduction in caseloads as part of their PIP in order 

to improve outcomes for children and families, e.g., the District of 

Columbia and Georgia. Yet, the Federal government has limited resources 

to offer States in these efforts and the training and technical 

assistance offered by the ten resource centers funded by the Children’s 

Bureau are focused specifically on those areas where there are Federal 

legislative or regulatory requirements that the States must achieve.



Each State will have completed a Statewide assessment by October 2004. 

The CFS reviews help identify strengths the States have to build on and 

the needs they should address in program improvement plans.



[End of section]



Appendix IV: GAO Contacts and Acknowledgments:



GAO Contacts:



Diana Pietrowiak, (202) 512-6239

Joy Gambino, (202) 512-2838:



Acknowledgments:



In addition to those named above, Gwendolyn Adelekun, Nancy Cosentino, 

and Nila Garces made key contributions to this report. Barbara Alsip, 

Avrum Ashery, Patrick DiBattista, Catherine Hurley, and Luann Moy also 

provided key technical assistance.



[End of section]



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Make a Difference?” Social Work, Vol. 35. No. 1. 1990.



Dickinson, Nancy S., and Robin Perry. Do MSW Graduates Stay in Public 

Child Welfare? Factors Influencing the Burnout and Retention Rates of 

Specially Educated Child Welfare Workers. The California Social Work 

Education Center. University of California at Berkeley, August 1998.



Doelling, Carol Nesslein, and Barbara Matz. Social Work Career 

Development Group. Job Market Report on 2000 MSW Graduates. George 

Warren Brown School of Social Work. Washington University, St. Louis, 

MO. N.p., n.d.



Doelling, Carol Nesslein, and Karen Joseph Robards. Excerpts from 1996-

2000 Alumni Survey Self-Study Report. George Warren Brown School of 

Social Work. Washington University in St. Louis, St. Louis, MO. August 

2001.



Fox, S., D. Burnham, A.P. Barbee, and P. Yankeelov. “Public School to 

Work: Social Work that is! Maximizing Agency/University Partnerships in 

Preparing Child Welfare Workers.” Training and Development in Human 

Services, I. 2000:



Fox, S., V. Miller, and A. P. Barbee. “Finding and Keeping Child 

Welfare Workers: Effective Use of Title IV-E Training Funds.” Journal 

of Human Behavior in the Social Environment (forthcoming).



Gansle, Kristin and Bert Ellett. “Louisiana Title IV-E Program Begins 

Evaluation Process.” Partnerships for Child Welfare, Vol. 5, No. 5. 

February 1998.



Graef, Michelle I. and Erick L. Hill. “Costing Child Protective 

Services Staff Turnover.” Child Welfare. Sept/Oct. 2000.



Jones, Loring P. and Amy Okamura. “Reprofessionalizing Child Welfare 

Services: An Evaluation of Title IV-E Training.” Research on Social 

Work Practice. September 2000.



Malm, Karin, et al. Running to Keep in Place: The Continuing Evolution 

of Our Nation’s Child Welfare System. Urban Institute, Occasional Paper 

Number 54. October 2001.



Meyer, Lori. “State Incentive Programs for Recruiting Teachers. Are 

They Effective in Reducing Shortages?” Issues in Brief, National 

Association of State Boards of Education. October 2002.



The Network for Excellence in Human Services. Workforce Analysis for 

Riverside County Department of Public Social Services. October 2001.



The Network for Excellence in Human Services. Workforce Analysis for 

Imperial County Department of Social Services. March 2001.



New York State Office of Children and Family Services, Bureau of 

Training. 2001 Caseworker Turnover Survey. May 2002.



Pasztor, Eileen Mayers, et al. Demand for Social Workers in California. 

California State University, Long Beach. April 2002.



Robin, S. and C.D. Hollister. “Career Paths and Contributions of Four 

Cohorts of IV-E Funded MSW Child Welfare Graduates.” Journal of Health 

and Social Policy, Vol. 15, No. 3/4. 2002.



Scannapieco, Maria and Kelli Connell-Carrick. “Do Collaborations with 

Schools of Social Work Make a Difference for the Field of Child 

Welfare? Practice, Retention, and Curriculum.” Journal of Human 

Behavior in the Social Environment. 2003.



South Carolina Association of Children’s Homes and Family Services. 

Comparative Study of Salaries and Benefits of Direct Care Workers in 

Member Agencies and Selected South Carolina State Government Positions. 

Lexington, S.C.: January 2000.



U.S. Department of Health and Human Services, Administration for 

Children and Families, Administration for Children, Youth, and 

Families, Children’s Bureau. Changing Paradigms of Child Welfare 

Practice: Responding to Opportunities and Challenges. 1999 Child 

Welfare Training Symposium. June 1999.



U.S. Department of Health and Human Services, Administration for 

Children and Families, Administration for Children, Youth, and 

Families, Commission’s Office of Research and Evaluation, and the 

Children’s Bureau. National Survey of Child and Adolescent Well Being 

(NSCAW). State Child Welfare Agency Survey: Report. June 2001.



U.S. Department of Health and Human Services, Office of Inspector 

General, Office of Evaluation and Investigations. Accreditation Of 

Public Child Welfare Agencies. March 1994. OEI-O4-94-00010.



U.S. Department of Labor, Bureau of Labor Statistics. 2000 National 

Occupational Employment and Wage Estimates.



Zlotnik, Joan Levy. “Enhancing Child Welfare Service Delivery: 

Promoting Agency-Social Work Education Partnerships.” Policy and 

Practice, Vol. 59, No. 1. 2001.



Zlotnik, Joan Levy. “Selected Resources on the Efficacy of Social Work 

for Public Child Welfare Practice.” Council on Social Work Education, 

June 11, 1999.



[End of section]



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FOOTNOTES



[1] States and/or counties may also subcontract the delivery of child 

welfare services, such as family support services or adoption planning, 

to private agency providers. 



[2] Child welfare caseworkers are considered caseworkers, case 

managers, investigators, or child welfare specialists, depending on 

their particular agency’s classification scheme. 



[3] Exit interviews seek to obtain information from employees on why 

they are leaving their current positions. Such interviews may be 

conducted orally or through use of a written survey, and their design 

and content vary widely across jurisdictions. One limitation of these 

interviews is that workers may not be candid in their disclosure of 

information because they do not wish to sever relationships with 

coworkers and managers. 



[4] HHS reviewed an additional five states in fiscal year 2002, but 

these reports were not released in time for our analysis.



[5] Child Welfare League of America “Minimum Education Required by 

State Child Welfare Agencies, Percent, By Degree Type, 1998.” State 

Child Welfare Agency Survey. 1999



[6] Albers, E. et al (1993). “Children in foster care: Possible factors 

affecting permanency planning.” Child and Adolescent Social Work 

Journal, 10(4). Dhooper, S.S., et al (1990). “Does social work 

education make a difference?” Social Work, 35(1).



[7] Under the Social Security Act [42 U.S.C. §674(a)(3)(a)], the 

federal government reimburses 75 percent of states’ training 

expenditures related to foster care and adoption services. Pursuant to 

HHS regulations, states providing training for contracted private 

agency staff can receive 50 percent federal reimbursement for this 

purpose.



[8] The District of Columbia, Massachusetts, and Puerto Rico have not 

participated in 

Title IV-E reimbursements for at least the last 2 fiscal years.



[9] Although the other discretionary grant programs fund initiatives 

that can involve caseworker training, caseworker training and 

development is not their primary focus. 



[10] In commenting on a draft of this report, HHS noted that the CFSR 

assesses state performance on 23 measures, which make up the seven 

outcomes related to safety, permanency, and well-being in cases and an 

additional 22 measures, which make up the seven federally required 

system factors that states must have in place by federal law and/or 

regulation. 



[11] These provisions were originally introduced by both the House and 

the Senate in the 107TH Congress as the “Keeping Children and Families 

Safe Act of 2002,” H.R. 5601 and S. 2998.



[12] These provisions were originally introduced in the 107TH Congress 

as part of the Child Protection Services Improvement Act, H.R. 1371. 



[13] According to our analysis and categorization of exit interview 

documents obtained, the top five reasons child welfare workers gave for 

leaving were: other--including retirement, stay at home, return to 

school, and undisclosed personal reasons (59.15 percent); stress/

burnout/workload (14.7 percent); inadequate compensation (13.85 

percent); alternate employment (13.5 percent); and relocation (10.77 

percent).



[14] Most states require teachers to take multiple state certification 

examinations in order to become certified to teach in certain subject 

areas. However, qualifications for teachers vary by state, and the 

current debate centers around permitting uncertified teachers to teach 

while receiving their training at night or on weekends.



[15] U.S. Department of Labor, Bureau of Labor Statistics. 2000 

National Occupational Employment and Wage Estimates.



[16] This amount is specific to child, family, and school social 

workers (the occupation under which caseworkers would likely be 

classified).



[17] California Alliance of Child and Family Services. Comparison of 

Foster Care Funding for the Wages of Child Care Workers and Social 

Workers in Group Homes with Wages in Other Occupations. July 1, 2001.



[18] South Carolina Association of Children’s Homes and Family 

Services. Comparative Study of Salaries and Benefits of Direct Care 

Workers in Member Agencies and Selected South Carolina State Government 

Positions. Lexington, S.C. January 2000.



[19] New York State Office of Children and Family Services, Bureau of 

Training. 2001 Caseworker Turnover Survey. May 2002.



[20] American Federation of State, County, Municipal Employees. Double 

Jeopardy: Caseworkers at Risk Helping At-Risk Children: A Report on the 

Working Conditions Facing Child Welfare Workers, 1998.



[21] American Public Human Services Association. Report from the Child 

Welfare Workforce Survey: State and County Data and Findings, May 2001.



[22] Among other things, labor unions work to improve the availability 

and quality of support services, promote continuing education, and 

foster effective staff relationships with management.



[23] Malm, Karin, et al. Running to Keep in Place: The Continuing 

Evolution of Our Nation’s Child Welfare System. Urban Institute, 

Occasional Paper Number 54, October 2001.



[24] Network for Excellence in Human Services. Workforce Analysis for 

Riverside County Department of Public Social Services. October 2001.



[25] Network for Excellence in Human Services, Workforce Analysis for 

Imperial County Department of Social Services. March 2001.



[26] HHS officials told us that Child Abuse Prevention and Treatment 

Act funds are available for this type of training. 



[27] ASFA allows for various exemptions from the 15-of 22-month 

provision. Under ASFA, states are not required to file for a TPR if the 

child is being cared for by a relative; the state documents a 

compelling reason why filing a petition to terminate parental rights is 

not in the child’s best interests; or the state has not provided 

services needed to make the home safe for the child’s return.



[28] Of the 10 available PIPs, five states include specific measures to 

address high caseloads, inadequate staffing levels, and new worker 

training.



[29] The relationship between state agencies and the universities with 

which they partner varies by state. Some partnerships are more 

collaborative than others; in some states the agency acts only as a 

conduit of federal dollars, while in others, agencies work with schools 

of social work to shape the curriculum and design the internship 

program. In commenting on a draft of this report, ACF said that HHS’s 

child welfare training grant program has fostered stronger partnerships 

by requiring schools of social work to collaborate with state child 

welfare agencies in designing their programs. 



[30] Robin, S.C, and C.D. Hollister. Career Paths and Contributions of 

Four Cohorts of IV-E Funded MSW Child Welfare Graduates. School of 

Social Work, Journal of Health and Social Policy, vol. 15, no.3/4 

(2002).



[31] Fox, S., Miller, V. & Barbee, A.P. Finding and Keeping Child 

Welfare Workers: Effective Use of Title IV-E Training Funds. Journal of 

Human Behavior in the Social Environment (forthcoming).



[32] Jones, Loring P. and Amy Okamura. “Reprofessionalizing Child 

Welfare Services: An Evaluation of Title IV-E Training.” Research on 

Social Work Practice, September 2000. Ongoing research in Louisiana 

also found similar results. IV-E participants score higher on child 

welfare competency exams than control groups, have higher rates of 

retention within the agency, and score higher on supervisor evaluations 

of their work preparation (Ellett, Bert and Kristin Gansle. “Louisiana 

Title IV-E Program Begins Evaluation Process.” Partnerships for Child 

Welfare, Vol. 5, No.5. February 1998).



[33] Agencies’ capacities to meet and comply with COA accreditation 

standards are assessed through a formal review process. Accredited 

agencies are reevaluated at least every 4 years to maintain their 

status. 



[34] As of December 2002, there were 1,090 accredited private child 

welfare agencies. In addition to Illinois and Kentucky, whose entire 

systems are accredited, 12 states have at least one accredited county 

or local child welfare office.



[35] A receivership is an arrangement in which a court appoints a 

person to temporarily manage a local agency with broad authority to 

ensure full compliance with the court order in an expeditious manner.



[36] U.S. Department of Health and Human Services, Office of Inspector 

General, Office of Evaluation and Inspections. Accreditation of Public 

Child Welfare Agencies. March 1994. OEI-O4-94-00010. 



[37] Although accredited agencies are required to submit yearly 

Maintenance of Accreditation reports to COA, according to one COA 

official, there is no mechanism in place to certify agencies’ 

compliance with the accrediting standards on a daily or monthly basis.



[38] In commenting on a draft of this report, ACF noted that it has 

fostered the identification of caseworker competencies by requiring 

clear delineation of worker competencies as a basis for curriculum 

development in announcements for child welfare training fund proposals. 





[39] Meyer, Lori. “State Incentive Programs for Recruiting Teachers. 

Are They Effective in Reducing Shortages?” Issues in Brief, National 

Association of State Boards of Education, October 2002.



[40] Of the 444 county agencies in our sample, 100 were intentionally 

selected--to ensure adequate representation of urban and rural areas--

because they are located in the 5 least populated and 5 most populated 

counties in each of the 10 states, and 344 were selected through 

randomization of each state’s remaining midsize counties. 



[41] The eleventh county-administered state--California--sent our 

survey to all 58 of its counties. 



[42] These numbers do not include agencies that were willing to share 

exit interviews with us but had no staff leave during the specified 

period.



[43] Some agencies--originally indicating that they were willing to 

share their exit interview documents--did not do so, while other 

agencies--originally unwilling to share their documents--ultimately 

provided them.



[44] HHS reviewed an additional five states in fiscal year 2002, but 

these reports were not available at the time of our analysis.



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