Child Welfare Caseworker Visits with Children and Parents

Innovations in State Policy

September, 2006

This report provides information about the potential of effective child welfare caseworker visits in achieving positive outcomes for children and families, both those receiving in-home and foster care services. It also offers strategies for legislators who are interested in supporting child welfare agency administrators in enhancing the quality and frequency of those visits.

Introduction
Child and Family Services at a Glance
The Role of Child Welfare and the Importance of Caseworker Visits
State Policies on Caseworker Visits for Foster Care
Caseworker Tasks, Caseload and Caseworker Visits
CFSR Findings Regarding Caseworker Visits
Quality Caseworker Visits
What Can State Legislators Do?
Comprehensive Approach to Promoting Quality Caseworker Visits
Notes

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Introduction

The case of Sara, age 6, was reported to the state child welfare agency by a teacher after the child came to school covered with bruises. Agency staff conducted the initial investigation, determined that Sara (but not her two younger siblings) had been abused by their father following a drinking episode, and then assessed the children’s current safety and risk of future harm. Because the father was temporarily living outside the family home and the mother indicated her interest in receiving agency services and supports to protect her children, the staff recommended that the family receive in-home services. Sara and her family were assigned a caseworker, who conducted a follow-up safety and risk assessment and met with the family to develop a safety plan (to include dealing with potential safety issues during visits by the father) and to discuss their needs.

The caseworker, after jointly conducting the needs assessment with all family members (including the father), then arranged for the family to receive services that were individualized to address the issues that they identified as leading to the reported incident, as well as services to enhance the family’s overall well-being. The caseworker subsequently met with the family every two weeks for the first two months and monthly thereafter until the case was closed. During those visits, the caseworker sought to ensure the safety of the children, monitored the implementation of the safety plan, and assessed the family’s engagement in, and response to, the services provided.¹

State legislators know that cases such as Sara’s happen every day across America. The communities they represent are challenged by the effects of child abuse. Yet, the families in those communities benefit when child welfare services work effectively. Central to those child welfare services is the role of caseworkers, especially their interactions with children and families engaged in agency services. These interactions are known in the field as “caseworker visits.”

Caseworker visits provide an opportunity for child welfare staff to spend time with families and to observe them in their homes and in other settings. During these visits, caseworkers build relationships with families that enable them to help the families more effectively respond to crises, opportunities, and child and family needs. Caseworker visits also enable child welfare agencies to set boundaries; they are a statement that child safety is the priority and that caseworkers will monitor each child’s circumstances and hold adults accountable for their well-being. Effective caseworker visits provide a community framework for children—that of protection and support—when families are struggling to care for them.

Although child welfare experts have always known that caseworker visits are important, evidence now shows the extent to which such visits may be linked to positive outcomes for children and families who are engaged in child welfare systems. Findings from the federal Child and Family Service Reviews (CFSRs), which examine state child welfare agency performance, have shown an association between a positive rating on caseworker visits and positive ratings on other areas under review.² The Children’s Bureau, U.S. Department of Health and Human Services, which administers the CFSRs, believes that one of the most important ways to promote positive outcomes for children and their families is to ensure the quality and frequency of caseworker visits with the children and families in the agency’s care. (See box for more information about the reviews.

Child and Family Services Reviews At A Glance

Congressionally authorized review of state child welfare systems.
The first round of reviews, conducted from 2000 to 2004, was administered by the Central and Regional Offices of the Administration for Children and Families, U.S. Department of Health and Human Services.
States conduct their own Statewide Assessment with support from the federal government.
Federal and state teams conduct an onsite review of three sites in the state; the teams examine outcomes for a sample of children and families served by the state child welfare agency.
States prepare a Program Improvement Plan to develop or enhance policies, training and practice identified as needing improvement.
Federal penalties apply if states do not make the required improvements.

Welfare Outcomes Assessed by the Reviews

Safety: Children are protected from abuse and neglect and are safely maintained in their homes whenever possible and appropriate.
Permanency: Children have permanency and stability in their living situations and continuity in their family relationships and connections.
Child and family well-being: Families are better able to provide for their children’s needs, and children are provided services that meet their educational, physical health and mental health needs.

Performance Is Assessed Through the Reviews

State child welfare data are compared with national standards.
Qualitative information on state performance is collected through reviews of actual case records and interviews with children, families and others.
State performance is evaluated with regard to how well critical components of the child welfare system function (“systemic factors,” such as the agency’s responsiveness to the community and the training of child welfare staff).

More information about the Child and Family Services Reviews is available at http://www.acf.hhs.gov/programs/cb/cwmonitoring/index.htm#cfsr.

State legislators can help promote the delivery of quality caseworker visits through their budgetary and oversight roles. In their role as the appropriators of funds for child welfare agencies, state legislators can mandate caseload and workload studies and authorize funding for additional caseworkers as needed. In providing oversight of state child welfare systems, legislators can support child welfare agency administrators in identifying best practices in casework and ensuring that staff are trained and supervised on those practices. They also can jointly monitor outcomes for children and families who are engaged in child welfare services.

State legislators therefore can have an enormous positive influence on important child welfare practices; to do so, it is critical that they fully understand the role of caseworker visits in protecting children and promoting the well-being of children and families.

The Role of Child Welfare and the Importance of Caseworker Visits

Every state has a public agency that is charged with the delivery of services in response to reports of child abuse and neglect. These child welfare agencies also play a role in prevention and early intervention, and they are required to ensure a child’s safety when the child is abused or neglected or when a caregiver is unable or unwilling to protect his or her child. They do so by receiving and assessing allegations of abuse and neglect, assessing children’s safety and risk of future harm, evaluating a family’s capacity to participate in services provided, and planning and coordinating services and interventions for the child and family.³ In addition, these agencies are involved in determining whether children need to be removed from their homes. More important, once children enter the child welfare system, child welfare agencies are responsible for monitoring their ongoing safety and providing services to promote their well-being and that of their families.

Child welfare agencies conduct these activities by assigning caseworkers to families that come to the attention of the child welfare system. Caseworkers work closely with families, conducting regular visits with intact families and with children in foster care and facilitating visitation between family members when children are placed outside the home.

These caseworker visits are a critical component of child welfare system procedures for ensuring the safety of children and the well-being of families. Caseworkers meet with children and families to monitor children’s safety and well-being; assess the ongoing service needs of children, families and foster parents; engage biological and foster parents in developing case plans; assess permanency options for the child; monitor family progress toward established goals; and ensure that children and parents are receiving necessary services. At each stage of the intervention, caseworkers, with the support of their supervisors, determine the type of supports that children and their families need to ensure that the children are safe, are in or moving toward permanent homes, and have stable living arrangements that promote their well-being.

State Policies on Caseworker Visits for Foster Care

Although no federal standards currently exist regarding specific activities that caseworkers should perform during visits with children in foster care, a number of states have written standards.

Frequency: Forty-three states have statewide written standards that require caseworkers to visit children in foster care at least monthly.⁴
Quality: Forty-one states have reported implementing standards that address the content of caseworker visits with children in foster care; 38 of these have written standards specific to caseworker visits, such as the following:

– Address safety needs, including monthly face-to-face contact with children in foster care.

– Promote communication between the children and the caseworker (to address children’s concerns and adjustment to placement), between the caseworker and other family members, and between children in care and other family members (visitation).⁵

Caseworker Tasks, Caseload and Caseworker Visits

Caseworkers obviously play myriad roles when they intervene in the lives of children and families. In addition to their case management activities, caseworkers prepare for and attend court hearings, arrange for and facilitate visitation among family members, manage crisis situations, and handle vital administrative duties. These include documenting case histories, managing case records, and entering case data into the state’s child welfare management information system. Ensuring that caseworkers have the time needed to visit with children and families requires that they have a manageable caseload size.

The Child Welfare League of America (CWLA), one of the national organizations that represents and provides training for the child welfare field, has recommended standards of excellence for caseload ratios for workers in child welfare program areas. Although CWLA acknowledges that computing caseload size is an inexact science, it suggests that states err on the side of ensuring child safety and well-being. To that end, CWLA recommends developing a maximum number of cases per worker by considering such elements as the position (for example, investigative staff versus case manager), the range of other tasks expected of a worker (for example, work with community groups), and the time period (cases per day or cases per month).⁶

Although caseload size plays a significant role in the quality and frequency of caseworker visits, it is not the only—or perhaps the most important—variable. Others include effective case assignment strategies (for example, that take into consideration case type, level of effort required and geographic location); creative workload management techniques (for example, visiting families with extensive problems early in the week so that identified issues might be addressed before too much time elapses); and sufficient resources to perform caseworker functions (for example, access to time-saving technologies or transportation).

Moreover, the quality of caseworker visits appears to be correlated with better outcomes in other areas, as indicated by the federal CFSRs. Those findings suggest a need for a more comprehensive approach to enhancing caseworker visits.

CFSR Findings Regarding Caseworker Visits

The first round of the federal CFSRs, conducted between 2001 and 2004 in all states, the District of Columbia and Puerto Rico, provided a snapshot of the relationship between caseworker visits and how children and families fare when engaged in child welfare services. (“Caseworker visits with child” and “caseworker visits with parents” are two items reviewed through the CFSRs; see the box “Child and Family Services Reviews at a Glance” for information about the reviews.)

The quality and frequency of caseworker visits—how caseworkers interact with children and families, what they discuss and how often they visit—are associated with a range of state child welfare actions that are reviewed through the CFSRs. The reviews showed that, when state child welfare agencies do well on the caseworker visits, they are better positioned to assess children’s risk of harm and need for alternative permanency options, to identify and provide needed services, and to engage children and parents in planning for their future.⁷

The reviews also identified common concerns regarding caseworker visits, including insufficient face-to-face contacts with children or parents to address their safety and well-being and an inconsistent focus on issues regarding case plans and goals during visits.⁸ These concerns suggest the need for state requirements regarding the frequency of face-to-face contact with children in care and both standards for and training on how to conduct quality caseworker visits with children and their parents.

Quality Caseworker Visits

So what comprises a quality caseworker visit? There certainly are key elements that quality visits should include. For example, they should be:

Scheduled to meet suggested national or prescribed state standards and the needs of children and families.
Primarily held in the family home (biological and foster) and at times convenient for children and both biological and foster parents.
Planned in advance of the visit, with issues noted for exploration and goals established for the time spent together.
Open enough to offer opportunities for meaningful consultation with and by children and parents.
Individualized; for example, providing separate time for discussions with children and parents. This provides the opportunity to privately share their experiences and concerns and to ensure that domestic violence or other issues that might not be disclosed when other family members are present are identified and addressed, as needed.
Focused on the child and family’s case plan and the completion of actions necessary to support children and families in achieving the goals established in their plans.
Exploratory in nature, examining changes in the child’s or family’s circumstances on an ongoing basis.
Supportive and skill-generating, so that children and families feel safe in dealing with challenges and change and have the tools to take advantage of new opportunities.

Although these and other caseworker visit practices are important, the overall focus of the visits is most important. For caseworker visits to be successful, the focus should shift from examining only the performance of families (for example, did the parent attend the substance abuse treatment offered?) to assessing both the performance of the agency and caseworker (for example, did the agency ensure that the treatment matched the needs, age and gender of the intended recipient and was available at a time and location appropriate to their schedule?) and how well the family is functioning relative to the support and services provided by the agency.

This fundamental shift in perspective promotes caseworker engagement in a continuous quality improvement loop similar to that which most child welfare agencies are now implementing. Their goals for a visit with a family are casework goals and goals related to a family’s progress. Moreover, child welfare agencies should monitor the link between the achievement of the caseworker’s goals and the achievement of family goals. When assessing a visit, caseworkers might ask the following general questions (as well as others specific to the family visited):

Did I spend sufficient time planning the visit, did I meet the goals established for the visit, and what were the positive outcomes for the family associated with meeting my goals?
What worked well during this visit, and how might I share my successful approaches with other agency staff? How will I track patterns in the success of specific approaches so that I might report those to my supervisor for possible incorporation into the agency’s case practice procedures?
What types of challenges did I experience during the visit and how might I have addressed those better? Are there specific areas in which I need additional guidance or training?
What did I learn through the visit that needs to be addressed (family needs/goals and caseworker performance goals)?

Each question is designed to create a new level of self-examination among caseworkers—a continuous quality examination that will lead to improvements in individual caseworker and agency performance. Legislators can support state child welfare agency administrators in creating this shift in perspective and operation through the analysis of overarching child welfare system successes and challenges.

What Can State Legislators Do?

Caseworker visits with children and families are at the heart of child welfare practice. Legislators might consult with child welfare administrators about how best to promote caseworker visits with an appropriate focus and frequency. State legislators and their staff can initiate those discussions using the following questions.

How would the child welfare agency administrator describe the state standards (or policies) for ensuring that caseworker visits are conducted with the frequency and quality (focus/content) necessary to protect children’s safety and promote child and family well-being?
How do caseworker visit strategies complement or support other important child welfare practices?
If the state does not have standards or policies, is the administrator planning to develop or implement such standards?
How does the child welfare agency train staff on the standards/policies and the role of caseworker visits in achieving positive outcomes for children and families? How might they do so more effectively?
What is the role of supervisors in promoting the quality and timeliness of caseworker visits? How does the agency support supervisors in undertaking these activities?
How does the state monitor the quality and frequency of caseworker visits by caseworker, by agency and statewide?
Does the agency examine the link between caseworker visits and outcomes for children and families, for example, through analysis of agency data or quality assurance results?
Is the state meeting the established caseworker visit standards? If not, what is the state doing to analyze and then address the barriers to doing so?
Are there requirements and/or restrictions in state law or policy that can be eliminated or modified to enable caseworkers to devote more time to visits with children and families and to conduct those more effectively?
Has the child welfare agency conducted an analysis of current caseworker caseloads, responsibilities, turnover or access to time-saving technologies? What is the effect of these on achieving positive outcomes for children and families generally and on conducting routine and supportive caseworker visits specifically? If the agency has conducted this analysis, what were the findings and what does the agency need to be able to address the identified issues?
How is the child welfare agency engaging its community partners and other state and local agencies in supporting and monitoring children and families in the child welfare system? What can state legislators and elected officials/political leaders do to support the agency’s efforts to involve others and integrate caseworker visits into a broader, community-based effort on behalf of families?
What type of resources does the child welfare agency need to enhance caseworker visits with children and parents?

Comprehensive Approach to Promoting Quality Caseworker Visits

As with all child welfare policies and practices, caseworker visits do not exist in a vacuum. They are part of an overall system in which change in one area has implications for other arenas.

To be effective, all good social service reform begins with a re-examination of the organization’s mission and its process for establishing policies and practice standards in support of that mission, providing training to and supervising staff, and managing the quality assurance loop that generates continuous quality improvement throughout the organization. This is especially true for child welfare agencies; in fact, changes to individual policies or practices will not remedy what ails most child welfare systems. Instead, leaders should continually take stock of their efforts by analyzing whether existing policies and procedures are helping the agency achieve its mission. At the core of that mission is, of course, the protection of children and the promotion of stronger families. It now appears that caseworker visits—when they are of good quality and sufficient frequency—might be one of the central practices that supports that mission.

When considering improvements in caseworker visits, legislators therefore will want to coordinate with state child welfare agency administrators and other experts about the range of policies and practices that might contribute to improved visits. Although providing funding for more caseworker positions might be appropriate and necessary, legislators should first collaborate with child welfare administrators regarding the need for studies to examine the status of caseloads, determine the causes of high turnover and vacancy rates among child welfare workers, assess the quality and frequency of caseworker visits, and identify ways to increase caseworker efficiencies and shift certain tasks to support personnel.

Once guided by sufficient information, legislators and child welfare administrators can establish pilot programs to test innovative ways to promote quality caseworker visits or to address issues that are preventing such visits. This might include, for example, achieving lower vacancy rates by hiring new caseworkers in anticipation of vacancies, rather than hiring as vacancies occur. Legislators also can request a review of their state’s civil service system to determine whether there are ways to streamline employee classification, hiring and performance reviews, or address compensation issues to make these processes more responsive to the unique needs of the child welfare system. More important, legislators and child welfare administrators might focus on improving the actual activities that comprise a caseworker visit by redesigning caseworker practice guidelines and offering new and enhanced training and supervision to staff.

Caseworker visits are a vital component of state child welfare agency efforts to address the needs of abused and neglected children and their families. State legislators can engage state child welfare agency administrators in examining every aspect of state law, policy and funding to determine how to most effectively promote caseworker visits that are frequent enough, and, more important, focused on protecting children and supporting them and their families in achieving positive outcomes.

Notes

1. Please note that this is an illustrative child welfare case example and is not representative of a specific child.

2. Administration for Children and Families, U.S. Department of Health and Human Services, Findings From the Initial Child and Family Services Reviews, 2001–2004, available at http://www.acf.hhs.gov/programs/cb/cwmonitoring/results/index.htm.

3. Charmaigne Britain and Deborah Hunt, eds., Helping in Child Protective Services: A Competency Based Casework Handbook (Oxford: Oxford University Press, 2004).

4. Office of Inspector General, U.S. Department of Health and Human Services. State Standards and Capacity to Track Frequency of Caseworker Visits with Children in Foster Care (Washington, D.C.: DHHS, 2005).

5. Office of Inspector General, U.S. Department of Health and Human Services, State Standards and Practices for Content of Caseworker Visits with Children in Foster Care (Washington, D.C.: DHHS, 2005).

6. Child Welfare League of America, Guidelines for Computing Caseload Standards, http://www.cwla.org/programs/standards/caseloadstandards.htm, May 2006.

7. Administration for Children and Families, U.S Department of Health and Human Services, Findings From the Initial Child and Family Services Reviews, 2001–2004. Available at http://www.acf.hhs.gov/programs/cb/cwmonitoring/results/index.htm.

8. Ibid.