Transformation that Gets Results
This issue is dedicated to “transformation” and the work we do to improve service for families, children, and clients. Improvement comes in many forms, a new technology system, and improved safety model, and new training to help our employees become the best versions of themselves. Each effort is driven by the hope that we can find ways to do more good with the resources entrusted to us. In child welfare, it seems that every year we are undergoing major transformation whether through our internal program improvement plans, or external initiatives like the Family First Act. Transformation and willingness to change is not our problem; finding the right kind of change and where to focus our effort is.
Our challenge is making significant and sustainable improvements through all the changes we face. If you look at your numbers and ask some of your seasoned staff members — Are we better off than we were a decade ago? Are better safety decisions being made? Do workers and community partners feel more supported? Do we have more confidence in the decisions we are making? Are outcomes better for children who leave foster care? Have we found meaningful ways to prevent children from coming into care in the first place?—What would they say? While they may say you are better off in some areas, it is likely they will have to admit that we are not where we need — and want — to be.
In one critical area — kids in care — we know there is work to be done. We know children are staying in care longer, we have fewer ideal foster options, and residential treatment is often used as a placement safety net. We also know we would like better results for kids. Not surprisingly, we have a new federal act —Family First — to help improve our efforts to keep families together and find the healthiest safe environments for children.
There is no doubt that Family First is all about the noble outcome of doing what is best for the child and the family. But to achieve this outcome, we need time—a precious commodity that an already capacity-strapped agency just does not have.
So how are agencies tackling the challenge of implementing Family First in a field that is already capacity challenged? In Idaho a major trans- formation is underway that includes finding process efficiencies and replacing aging technologies. One of the first lessons learned was that at the most critical moment in Child Protection, when staff put eyes on kids and determine if the child is safe or unsafe, there was a capacity issue. A full safety assessment takes between 16 hours when the child is safe, and up to 84 hours when a child is not safe and will be removed. Social workers would regularly get three to five new assignments per week, and in some cases, seven or more. That meant even if every child assessed was safe, a worker was assigned 48 hours of work in every 40-hour work week. While social workers performed the difficult task of trying to keep up with such a demanding workload, there was tremendous pressure and never enough time.
New initiatives, like Family First, usually add time that contributes to the immense pressure staff is under to determine the safety of children. Over time, when we have more work than time, something has to give. Whether it is the quality of our documentation, our ability to meet the deadline, or the enormous amount of documented and undocumented overtime we invest, there is always a price to pay. Each added minute can impact staff’s ability to make the right decision in a timely manner.
Imagine you are a modern assessment worker with four new assignments this week. The first thing needed is put eyes on the children to make sure there is no immediate threat to their well-being. During this initial meeting, typically there are three scenarios: (1) Clear Safe, there are no signs of abuse or neglect and no need for the agency to be involved; (2) Clear Unsafe, there is immediate risk that must be addressed by the agency; and (3) the Gray Area, where there is not enough known to make a decision and more time is needed to fully evaluate and determine if the child can be safe in their home. Of the four hypothetical cases you will want to spend more time in the gray, but the fourth case comes in—a child in imminent danger and officers are already on the scene to remove the child. Your plans to spend more time with the third family have been altered, and now you have the tough and time intensive job of deter- mining if that child can stay in the home … or not.
We know that social workers will not leave a child in harm’s way, so when something has to give, and there is no time, the only way to assure the child is safe until more assessment is done is to remove the child. Social workers don’t have time to consider in-home options, safety nets, and available family supports, so they scramble to find any placement until they can find time to do it right later.
This is the exact scenario we hope to avoid with Family First by taking the time for the children at risk of removal and see if they can remain safely at home with strong supports in place. But, to achieve Family First, it requires more time. It’s not that the concept is bad — it’s that it costs us time. The reason we fail to get the radical results we so desperately desire in all our transformations is that we fail to create what is critically needed to be successful. We fail to create time.
In Idaho, the transformation effort to create time and improve outcomes in child welfare was integral to and coordinated with their information technology system replacement. Like many states, the number of children coming into care exceeded the number of exits from care, staff was overworked, turnover was high, foster families were frustrated, costs for residential treatment continued to grow, and outcomes for children really had not changed in the last decade. Transformation was essential. The goal of transforming child welfare in Idaho was to find where the system was breaking down, discover efficiencies, and develop consistent and repeatable processes that produced better outcomes for children through business process redesign and technology improvements. (To learn more about this effort, check out a webinar that C!A and Idaho recently conducted in partnership with APHSA at https://vimeo.com/372912254/ed1b431553).
The Idaho redesign has led to incredible outcomes. After eight months of implementation, Idaho is realizing some massive capacity gains in safety assessments:
- Time to reach a safety decision decreased from an average of 57 days to less than 20;
- Time needed to fully assess a child’s safety reduced by 50 percent;
- Field staff capacity increased by 30 percent;
- Open safety assessments reduced by 65 percent;
- Staff confidence increased in making the right safety assessment decision; and
- Time has been created to ensure the safety assessment model is practiced to fidelity.
It is evident that workers having adequate time — time with families to assure children are safe and loved — is the first step. That’s what transformation in child welfare means: constantly changing to meet the needs of children. It is what has called many of us to this profession and makes all the late hours and hectic days worthwhile.
The reward for Idaho’s transformation was time. Consequently, Idaho has reversed their trend of getting further behind to getting further ahead and doing it right. There have been some unanticipated and hard-to-measure benefits as well. Employees have reported feeling less stress. Families are getting answers faster. Managers know where every kid is in the process. They are just doing better work now that they have the capacity needed to follow their safety model despite an increase in the number of allegations coming in.
Transformation, to be successful, must include the creation of time. If our approach to change doesn’t build capacity, we only layer more change onto broken systems. With each change we risk adding so much more work that we create scenarios where we cannot possibly keep up, and in turn, we make decisions based within that limited timeframe. Inversely, when we build capacity, we increase staff confidence to make good decisions across the spectrum, but specifically with families in the gray area.
Good decisions lead to good outcomes.
In Idaho, the most shocking unanticipated result may be that they have implemented the vision behind Family First without consciously adding something to their practice. Just by creating time, they have found the number of removals has been steadily declining as assessment capacity has increased and they are making better decisions faster. It is far too early to attribute this reduction solely to their transformation, but it is undeniable that as they add key elements into their process there has been a direct correlation to removals.
To get to these results, Idaho built a work process where every safety assessment can complete a structured consult with a supervisor within five days of the child being seen. This facilitates a decision and prevents cases from lingering in the system. When a child is removed, there is now a quicker hand-of from safety assessor to case manager so an additional perspective can reconcile whether in-home services could be put in place to resolve the safety issue and, if not, clear conditions to return home are set. The entire process has been made visible through data so that every worker, supervisor, manager, and senior staff member sees how they are accountable to each child they interact with. While the redesign was geared to making sure Idaho had time to use their safety model and make the right decisions, there is no doubt that the time created is contributing to the goals of Family First.
It is evident that workers having adequate time — time with families to assure children are safe and loved — is the first step. That’s what transformation in child welfare means: constantly changing to meet the needs of children. It is what has called many of us to this profession and makes all the late hours and hectic days worthwhile. It’s the love for children in need that makes up for every bit of heartache, for every professional hardship. It’s love for healing a family or helping to find a new forever family.
It’s love that drives us. We don’t lack heart; we just lack time.
*Originally published as All We Need is Love…and Time (Policy & Practice, February 2020)