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Social workers are leaving the Idaho health department. Now, some case metrics are dropping.

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A social worker’s desk in Boise sits empty as Idaho Health and Welfare employees across Idaho, particularly in the Boise area, have been struggling under the weight of increasing workloads while more staffers leave and aren’t replaced. (Courtesy of Matt Devlin)

Ada County judge says quality social workers can make or break a child protection case

After nearly 30 years in the world of child protection, Ada County Magistrate Judge Andrew Ellis has worked with many different social workers. Probably hundreds, by this point.

He calls the job a “psychological meat grinder.”

As the Idaho Capital Sun has reported, turnover rates among mid-level social workers at the Idaho Department of Health and Welfare have been higher in the past two years, in part because some former social workers say workflow changes at the department made the job impossibly difficult and stressful.

Ellis is used to seeing new social workers burn out quickly and move on, but the recent departure of more veteran workers at the department has surprised him. 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.

Social workers with experience, knowledge and talent are vitally important, Ellis said, especially if a family’s case ends up in court, and losing them has clear consequences from his vantage point.

“The quality of the social worker directly translates to the success or failure of one of these cases. Somebody could go to the Department of Health and Welfare right now or look at files in the last couple years, and you would see a direct correlation between successful outcomes and the quality and competency of the social worker assigned,” Ellis said. “It sometimes hurts my ego, to be honest, because I like to think that I play a role, but the God’s honest truth is that the actual key to a child protection case first and foremost is the parent’s commitment to change … but secondarily, it is the quality of social work that is provided to that parent.”

Too few people, too much work, unpaid overtime at Idaho health department

During the 2021 fiscal year, 83 people voluntarily quit their jobs in the Child Welfare division of the Idaho Department of Health and Welfare. 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.

“If you have a social worker who is responsive, who is organized, who is making sure that services are offered quickly and following up to ensure the parent is complying and has just that unquantifiable sort of good human touch where they just can connect with people and encourage but not judge, those social workers achieve great outcomes compared to, say, the general population,” Ellis said.

Social workers across Idaho, and particularly in the Boise area, have been struggling under the weight of increasing workloads as more staffers leave and aren’t replaced. The number of calls for safety assessments, which occur when someone calls the Department of Health and Welfare out of concern that a child might be in danger, have only increased over the past year. Those who normally work in case management or as upper-level management are taking on safety assessment work because there simply aren’t enough people.

Less than half of the normal amount of safety assessors are still working in the Boise office — a problem that has been brewing since at least 2019, according to former staffers.

Health and Welfare Deputy Director Miren Unsworth told the Idaho Capital Sun that the redesign and changes to workflow have been positive, and reduced the case backlog by nearly 70%. Vacant positions are an issue the department is trying to address through recruitment efforts and training on how to manage burnout. But Unsworth said the problems would be much worse without the changes implemented in the redesign.

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. 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.

Fewer Idaho children reunited with parents in 2021

Case managers, who take over when an assessment determines a child is in an unsafe environment, are also taking on high caseloads. The standard recommendation is 10 to 12 cases per worker, but most are averaging 20 or more cases, some of which have multiple children involved.

On top of the already high workload, case managers and safety assessors have been assigned shifts at Airbnb rentals to stay with foster children who have no other options for placement. Social workers at Health and Welfare are also exempt employees, meaning they aren’t paid overtime for working more than 40 hours.

Former Boise case management supervisor Lorena Sorensen, who left the department in October after more than seven years there, said she and her staff routinely worked 60 hours per week and logged many hours of comp time. But with such high caseloads, the comp time that was earned went unused, even if a worker wanted to take vacation. Comp time also isn’t paid out when a worker quits.

“People don’t have the time to do the work. You don’t have the time that you need to be able to provide the families with the resources that they need to be able to support them, to help support the foster families,” Sorensen said.

The consequences of not having that time available may be starting to show in data from the department.

For a case manager, the primary goal at the end of a case is to reunite children with their parents or caregivers, Sorensen said. As long as it is safe and appropriate, children generally have better health outcomes when they can go back home. But that requires a social worker to work with the family to resolve the issues that led to a child coming into the state’s care in the first place, whether the problems were mental health, substance abuse or discipline related.

If a child comes out of foster care and is not reunified with caregivers, he or she is adopted.

But with heavy caseloads and extra process changes that have required case managers to take on more adoption and safety assessment work, reunification rates fell by 8% in the past year.

Unsworth said those numbers fluctuate in any given year and may have been influenced by the pandemic and backlogs in the court system.

“Can I say definitively what that’s related to? No, I can’t,” Unsworth said. “I think there’s probably a myriad of factors that played into that. Potentially there’s some things related to what that meant with case manager workloads, but I think it’s probably significantly more factors than that.”

Sorensen said cases become much more difficult when a social worker leaves and the case is transferred at a midway point to another worker. The relationships and knowledge of that particular family goes with the person who left, and the workload gets even larger.

“When you have three, four, five different case workers on a case because people quit, it just kind of makes things not move as quickly as they potentially could,” Sorensen said. “The social worker (ends up) just doing the bare minimum. They’re writing reports, they’re seeing kids, but that’s all.”

Idaho health department has seen a drop in timeliness of responses to safety calls

Safety assessments have also seen a drop in timely responses since 2019 as workers struggle to keep up with low staffing. When a referral is made to check on a child, it is given a priority status of one, two or three based on the reported allegations:

  • Priority I: The highest priority, when a child is believed to be in imminent danger, or a child has died, and abuse is suspected. An immediate response is required upon notification of a Priority I referral.
  • Priority II: For issues such as non-life-threatening physical abuse, neglect or sexual abuse. A social worker will respond within 48 hours of receiving the referral.
  • Priority III: For cases with circumstances such as adequate supervision for children, no proper food or shelter, or potentially dangerous living conditions. A social worker will respond within 72 hours of receiving the referral.

According to data from the Idaho Department of Health and Welfare, 12,526 assessments were assigned in fiscal year 2021, and adhered to the time standards defined in policy in 79.3% of cases. That percentage dropped from 81.4% in 2020, and 83.8% in 2019.
Broken out by priority status, the highest priority cases have only seen a slight decrease from 85% in 2019 to 84.4% in 2021. But Priority III referrals have dropped from 83.2% timely responses in 2019 to 77.7% in 2021.

Cameron Gilliland, administrator of Family and Community Services at the department, said every referral receives a response, but they are granting what’s called a variance when the timeliness standard can’t be met because teams are overwhelmed.

“It may take a little longer, but everything is seen, and everything is tracked,” Gilliland said. A regional manager is usually involved in the decision to grant a variance. “They’re very particular about those based on what the safety issue is. We get calls in for messy houses versus calls for physical abuse, or something like that.”

Fruitland Republican legislator says department needs to ask for more resources

Unsworth said the department plans to request 13 additional positions from the Idaho Legislature when the next session begins in January. The Child Protection Legislative Oversight Committee, which was formed following a report from the Office of Performance Evaluations on Idaho’s child care system in 2017, met on Dec. 10 to discuss various issues related to child welfare and is expected to meet again in early January.

Sen. Abby Lee, R-Fruitland, is chairwoman of the child protection committee and has questioned Unsworth at legislative meetings in prior years about low requests for additional positions. Lee said she is troubled by the number of children staying in Airbnbs and hotel rooms, and she hopes to see requests that match the need this year.

“I’m really looking for some better leadership from the department to make the requests that need to be made,” Lee said. “Our children in our state deserve to be safe, and primarily that’s their parents’ responsibility, but when parents are not, we’re going to step in and do that. So I’m looking at the department to put more resources into it.”

The Idaho Capital Sun is a nonprofit news organization delivering accountability reporting on state government, politics and policy in the Gem state.