Ben Franklin gets credit for the axiom, “An ounce of prevention is worth a pound of cure.” Today, this adage has been used to describe every.thing from flu shots to public safety and almost any situation where some “up-front work” will help you avoid more work or harsh consequences down the road. It makes perfect sense in child welfare: If we can get ahead of the problem, we not only save our over-tasked departments from needing to react to all of the high-priority emergencies, but we also save children from the very dire consequences of abuse and neglect.
The problem has never been that we fail to see the benefits of prevention—it has been the cost of the ounce.
There’s a popular show on the Discovery channel that follows gold miners through the Klondike in search of making their millions. I have been fascinated by how much work goes into pulling out small flakes of gold. Today’s gold price hovers around $1,500 per troy ounce, and the average cost of mining that ounce is reportedly $800.
So, as I watch the show, it always makes me think that walking away with $700 for every marble-sized nugget I could find doesn’t sound too bad. All I need is $800 to get started.
Of course, $700 won’t cover my travel expenses so to make real money—say a million dollars—I need to mine about 670 ounces of gold, and that would cost about $536,000. I don’t have that. I don’t even think I could borrow that. I simply cannot afford to mine gold unless I had a lot of money to begin with.
And that brings us back to child welfare. We all see the potential, we just don’t have the resources to invest. We are so consumed with the tasks at hand—reacting to emergencies and responding to the children that need us right now—that we don’t have the resources to dedicate to prevention. It takes everything we have to deal with the now.
A safety assessment takes about 20 hours to successfully complete, and workers report getting three to seven new assessments each week. Each child in care requires 12 to 18 hours per month of our time, and we regularly have way more than 15 caseloads. It is clear we are already running a negative balance. If we consider the time that assessments need like a weekly budget, this is where we are currently:
Weekly hours needed per worker in assessment: 60-140
Hours available: 40
Balance (per week, per worker): -20 to -80
In a year, that’s up to -4,160 hours per employee. Every worker needs to be doing the work of three workers just to keep up. So if we had resources, it would be irresponsible not to invest it back into these existing areas. Prevention is just not an option we can afford right now.
Or is it?
My best hope of finding $536,000 ranges between winning the lottery and finding a long-lost, rich relative. But in your organization—in your existing budget—we have discovered some interesting math that puts prevention within reach, maybe for the first time in decades.
One client we have worked with has found a way to rebalance their time budget by reducing the 20 hours needed in assessment to 10 to 14 and thus giving their workers a surplus for the first time in years. The secret was not a new information technology system, or a new safety model, or skipping steps, or limiting the kids we see—the secret was redesigning how they put their model into practice, how they document, and how they do quality assurance. The goal was to maintain the integrity of their safety model and ensure every child got a thorough assessment. The time saved does not put kids at risk, but rather enables workers to spend more time assessing in the home and less time documenting in the office. In this new process, they are looking at a time budget that looks more like this:
Weekly hours needed per worker in assessment: 30-40
Hours available: 40
Balance (per week, per worker): 0 to +10
Today, those +10 hours are used to clear backlog. But, with 60 percent of employees now carrying five or fewer open cases, soon those hours can be used for … well, whatever they need.
Building capacity is the secret to finding the resources to do all the things we have always wanted to do: dedicate more time to kids in care, offer better support to our foster families, make sure no case gets lost in the shuffle, and work on preventive programs to reduce child abuse and neglect. Like gold nuggets hiding under the frozen tundra, the opportunities are there for the mining. Once we find them, we have the ounces we need to dedicate to prevention that should only pay off in pounds of cure. It’s not desire or talent that holds us back, it’s resources. And the time to start digging deep … is now.
*Originally published as An Ounce of Prevention … (Policy & Practice, October 2019)