Social workers across Idaho have been leaving their jobs with the Department of Health and Welfare, saying the work environment and high caseloads are untenable, and those who remain are trying to sound the alarm to anyone who will listen.
But they say they frequently feel like they aren’t being heard.
Take January 2020, for instance, a few days before Department of Health and Welfare Deputy Director Miren Unsworth was scheduled to testify before the Joint Finance-Appropriations Committee at the Idaho Legislature. She asked staff for comments to share about how things were going with recent software upgrades and business process changes in the Child Welfare division.
Matt Devlin, who recently legally changed his name from Tim Walsh, was a supervisor overseeing safety assessment teams in Boise. He emailed a response that started with a positive note about the addition of mobile laptops to help save time and make it easier to take notes in the field.
But he also said workers in Boise were unable to see the full potential of the redesign, which cost the state $15 million and was intended to make case work more efficient, because of a lack of staff. That the changes had reduced the number of social workers in charge of safety assessments and forced members of other teams to take on safety work.
Regardless of the benefits of the redesign, Devlin said, the problems would remain without adequate staff.
A lead case manager in Boise took a similar approach, saying she was concerned that without a considerable commitment of resources, Child Welfare social workers would continue to have to make difficult decisions about which children and families most needed the help of limited staff resources.
When the day came, an archived recording shows when Unsworth made her presentation to the Legislature’s budget committee, she mentioned the mobile laptops and other positive comments about the redesign. But she requested just five additional social workers that would be split between Boise, Caldwell and Idaho Falls — not enough positions to fix the systematic problems felt by social workers, they said.
Devlin was angry and frustrated.
“This wasn’t the first time she didn’t ask for the additional staff, and it’s been no secret we were short on staff. And for her to only ask for those positions, to be split among three different regions — it sabotaged the potential that the redesign would have been able to allow us to see,” he said.
Unsworth told the Capital Sun she’s confident the problems with staffing would be much worse without the redesign changes.
“If we were still doing things the way we were historically, we would need a heck of a lot more staff than we have now. I think the turnover would be tremendously more significant,” Unsworth said. “So did we get as far as we wanted to go? No, but I do think there are complicating factors with COVID and (the labor market).”
Idaho’s mid-level social worker turnover rate increased by 17% over the past year
By the end of 2020, Devlin reached his breaking point and quit, saying he couldn’t protect his workers anymore and it was taking a toll on his mental health.
“I’ve never had a job before where I was encouraging my workers to (file for Family and Medical Leave) to protect themselves from something that they have no control over,” he said. “I asked the leadership, what are we not doing? What do we need to do differently? Not one of them could give me an answer.”
During the 2021 fiscal year, 83 people voluntarily quit their jobs in the Child Welfare division. At least 24 of those resignations were mid-level social workers, who said in their exit interviews that stress and workload was the primary reason they quit.
The job has never been an easy one, and turnover has historically been an issue. But the turnover among mid-level social workers jumped from 19% in 2020 to 36% in 2021, making it the fourth-highest turnover rate across the agency.
Unsworth said the redesign was a cultural shift that might not have been tolerable for the social workers who were used to doing their jobs in a different way. She also said it may be unrealistic to expect people to work for 30 to 40 years in the same place anymore. But she said the staff who have been there over the past two years performed admirably.
“What staff have been able to accomplish over the last several years in a very stressed system … it’s just nothing short of phenomenal and it’s also really, really hard,” Unsworth said. “That much change in that kind of window of time is exceptionally challenging.”
Prior to the redesign, the department said the average safety assessor had 32 open cases at any given time. Today, that average is down to 10 open cases, an almost 70% reduction. Unsworth said according to the department’s calculations, if current vacancies in staff were filled, the gap of 55 more workers would be filled with the 24 additions made in the past three years. But she acknowledged more will still be needed in the future.
“As the population increases, and we see a potential for increased workload, we will work closely with the Legislature to ensure we are addressing staffing needs immediately and responsibly,” Unsworth said.
Environment became more about data than children and families, former Health and Welfare social worker says
Former social workers who spoke with the Idaho Capital Sun said several factors drove them to quit — namely, the redesign of business processes that began in 2019. Along with modernizing the main software system for Child Welfare, the department wanted to refresh the approach to casework that had too often allowed backlogs to grow for months at a time.
The redesign would reduce the time required to complete case work, provide clear direction to social workers and reduce stress by lightening caseloads, agency leaders promised.
And maybe that would have happened, former and current employees say, if the department had retained its existing staff and added more social worker positions.
But as it was, those workers say the redesign made their already-difficult jobs impossible to do, heaping unrealistic goals on supervisors and field workers and demanding to know why when they weren’t met.
The employees said it caused so much stress, some of them were suicidal and had to go on medication. Some still cry about feeling forced to leave the job, grappling with guilt over abandoning the children and families they served.
The work environment pushed veteran social workers like Lorena Sorensen, who was a supervisor to case managers in Boise, to seek other employment. Sorensen was at the department for nearly seven years and had planned to retire there but left in October.
“It’s so heartbreaking to me. I felt like I didn’t have a choice. And I’m still heartbroken over it,” Sorensen said. “They knew that people were struggling, and they didn’t do anything.”
Former safety assessor Katie Mouser, who worked for Child Welfare in Boise for more than four years, left in April. She said the work was stressful from the beginning, but it got progressively worse through the business process changes.
“Definitely throughout my time there, it was a huge shift, and it became more about the data in our performance as far as how many cases we were able to close instead of the actual good work we were doing and our ability to engage families and kids in the community,” Mouser said.
Department has added 24 social worker positions since 2017 when they needed at least 57
Problems with overworked social workers at the department have been publicly known since at least 2017, when the Office of Performance Evaluations completed a report for the Idaho Legislature showing between 57 and 77 more social workers were needed. That number was largely the same in 2007, when the department cited a need for 75 more workers.
Idaho has added 271,524 residents since 2010, according toU.S. Census Bureau data, and 52,041 of those individualsarrived between 2020 and 2021.
Between 2007 and 2017, the report noted 18 full-time social worker positions were added. From 2017 to 2021, 16 additional social worker positions were requested, for a total of 24.
Unsworth said the department plans to request 10 more social workers and three psychosocial rehabilitation specialists, who are not licensed social workers but usually help with case work or other administrative tasks, from the Idaho Legislature in January. Those positions, if approved by the Legislature, would also be distributed across the state.
Following the Office of Performance Evaluations report, the department began a three-year transformation initiative to examine processes and standards. That initiative included replacing ICARE, the state’s information system, which was more than 20 years old.
The department selected Deloitte as the contractor to implement the new system, called Ensuring Safety and Permanency in Idaho — or ESPI — for $30 million over the course of three years. The federal government paid for half of that cost, while the state picked up the rest of the tab.
Implementation for the new system wrapped up in 2020, Unsworth said, but the company that helped the department develop new business practices is still on contract. That company, Change & Innovation Agency, received nearly $800,000 for its services in fiscal year 2019, and more than $750,000 in fiscal year 2020, according to state records.
New system of calling in reports took even more staffers out of field work
Devlin was part of a team of individuals who met monthly with Change & Innovation staff to brainstorm new approaches to safety assessment and casework that could reduce a large backlog of unclosed cases and documentation gaps, as well as cut down on the average number of days required to complete safety assessments.
A safety assessment occurs when a referral is called in to the department by someone concerned for a child’s welfare, such as a neighbor, teacher or counselor. A social worker is assigned to the case and visits the child’s home, conducts interviews and determines whether the child is safe, if they should be removed from a home, or if more information is needed before a decision can be made.
According to the department’s guidelines, a safety assessment case should be closed no more than 45 days from the time it is opened. Some were stretching out much longer than that, to more than a year, and that was an issue that needed attention, Devlin said.
The redesign set a goal of five days to make a decision for all safety assessments.
In many cases, five days would be enough time to determine if a child is safe. Some referrals happen because of a miscommunication, or a small issue that doesn’t endanger a child’s wellbeing. An average assessment where a child is clearly not in danger might take 10 to 11 hours of a worker’s time to complete, according to the department’s estimates.
If workers could keep those time frames to five days, the benefits would be twofold, according to internal emails obtained by the Idaho Capital Sun. Safety assessors would no longer have to work so many overtime hours, and the department wouldn’t need to add more staff.
Change & Innovation also suggested the formation of a new unit within Child Welfare called Central Consult, a team of seven social workers — one who works part time — who would answer calls from safety assessors and document their findings. Doing so would speed up the closure process, they thought, because the assessor wouldn’t need to find time to come back to the office and type up a report.
Most of the time, Unsworth said safety assessors are expected to call Central Consult on a case within seven days of responding to a referral. The average time in Region IV, which includes Ada County, is about 10 to 14 days.
“Some of our regions are getting closer to those goals; nobody is there today,” she said. “What it really is about is not so much the numbers, but it’s about (how) we want to know if there are cases out there that haven’t been consulted. … If that case needs to stay open, absolutely, but we want to know why and we want to have visibility into that case and what’s happening.”
For Mouser, the new system was more of a hindrance than a help. Not only was the staff too small initially, leading to wait times of over an hour on hold, but the idea itself didn’t make sense to her.
“My consistent feedback to anyone who would listen was that I had a really hard time talking my way through a case with someone who didn’t know me and didn’t know my work as a social worker,” Mouser said. “The whole process just felt very disjointed, and it felt weird having someone else do your documentation. It just creates one more area for things to go wrong.”
Staffing the Central Consult team also meant pulling more workers away from safety assessment field work, since the department didn’t request any new positions from the Idaho Legislature to staff Central Consult.
While the Region IV team typically has 17 safety assessors on staff, by 2021 it has dwindled to nine. According to Region IV safety assessor Tami Lauteren, only five of those nine workers are fully trained, including herself.
“I cannot possibly do the amount of work they’re asking me to do,” Lauteren said. “… You can’t take the hamster wheel and spin it faster.”
Devlin said he worked as hard as he could to meet the goals set up by the department, but it was never enough. He worked with his team to eliminate a backlog of open safety assessments that needed to be closed before the new software implementation, and his workers were taking on more assessments with greater efficiency month-to-month than they had been in 2019.
“We had never seen the caseload, the time it took from open to close, be that good. It was amazing. And yet we were being treated like we were worse than ever,” Devlin said. “But if you pointed that out, you weren’t being a team player.”
Looking ahead, Idaho director says filling vacancies will be key
Unsworth said if the department is able to request the 10 additional social workers and three rehabilitation specialists and fill the current vacancies, it would make a tremendous difference in workloads for social workers.
She hopes more can be done to bring new talent into the field as well.
“Anything that helps bring people of interest to us to do the work, to support the work, whether that’s volunteer or foster, that’s really our call to action right now,” she said. “That this is important work, this is challenging work, but this is work that’s essential to children and families in our community, and we need folks who have an interest to pursue that.”
Cameron Gilliland, administrator of Family and Community Services, said he is working on ideas for what staffing should look like in the next year, and may suggest additional staff for fiscal year 2023.
He has also been leading “fireside chats” to take questions from staff, and he’s launching a new class for staff on defeating burnout and other mental health tools.
“My vision is to have staff with enough time to do their job well, and I think that’s something staff deserve and something we plan on bringing to them,” Gilliland said.