SENATE. • • • • • . No. 1700 · 1992] SENATE - No. 1700 7 I [1 5 • The Departmentshould explore the causes ofthe apparent gender and minority based salary disparity which

(under the provisions of Section 63 of Chapter 3of the General Laws, as most recently amended by

Chapter 557 of the Acts of 1986.)

entitled

1700. No.• • •

of the

REPORT

• •

September 1992

SENATE COMMITTEE ON

SOCIAL WORKER CASELOAD

POST AUDIT AND OVERSIGHT

DEPARTMENT OF SOCIAL SERVICES

AND RESOURCE AVAILABILITY AT THE

SENATE.

1992] SENATE - No. 1700

tK;be tl:ommonlDealtb of _assaebasttts

3

MASSACHUSETTS SENATE

The Honorable William M. BulgerPresident of the Senate

SOCIAL WORKER CASELOADAND RESOURCE AVAILABILITY

AT THE DEPARTMENT OF SOCIAL SERVICES(Senate 1700)

A Report of the

SENATE COMMITTEE ONPOST AUDIT AND OVERSIGHT

Senator Thomas C. Norton, Chairman

Senator W. Paul White, Vice-ChairmanSenator Linda L. Melconian

Sen. Robert A. HavernSenator Robert D. WetmoreSenator Christopher M. LaneSenator Matthew J. Amorello

Prepared by the

SENATE POST AUDIT AND OVERSIGHT BUREAU

State House, Room 312Boston, Massachusetts 02133 (617)722-1252

Richard X. Connors, Esq., DirectorJames L. Hearns, Senior Policy AnalystAndrew J. Parker, Senior Fiscal AnalystBruce J. Prenda, Esq., Bureau CounselSteven H. O'Riordan, Policy Analyst

Claudia Andrea Bennett, Policy AnalystMichelle M. Blascio, Policy Analyst

Jacqueline M. Pomfret, Policy Analyst

Principal Researcher:Bruce J. Prenda, Esq.

September 1992

4 SENATE - No. 1700 [September

SENATE COMMITTEE O!\ POST Al'DIT AND OVERSIGHT

Room 312, State House Boston. MA 02133

SEN. THOMAS C. NORTON

Chairman(617) 722-1114

SEN. W. PAUL WHITE

V;"-t'-Chairman

HICIIARD X. COSSORS

Burt'uu f)irector(61,) ,22·1:1')2

Members

SEN. 1.INDA J. MELCONIAN

SEN. ROBERT A. HAVERN

SEN. ROBERT D. WETMORE

SEN. CHRISTOPHER M. LANE

SEN. MATnlEW J. AMORELLO

August 24, 1992.

~,w~~Vice-Chairman

Edward B. O'NeillClerk of the SenateState House, Room 208Boston, MA 02133

Dear Mr. O'Neill:

Pursuant to M.G.L. Chapter 3, Section 63 as most recentlyamended by Chapter 557 of the Acts of 1986, the Senate Committeeon Post Audit and Oversight respectfully submits to the full Senatethe following report: Social Worker Caseload and ResourceAvailability at the Department of Social Services.

This report is based on research by the Senate Post Audit andOversight Bureau. It examines social worker caseloads and resourcesand recommends ways to better manage cases of abuse and neglect.

Respectfully filed by the Senate Committee on Post Audit andOversight:

Senator Thomas C. NortonChairman

1992] SENATE - No. 1700 5

EXECUTIVE SUMMARY

The Massachusetts Senate Committee on Post Audit and Oversightconducted a limited performance evaluation of the Department ofSocial Services. The Committee selected the Department for a studybecause of the reported increased incidence of child abuse and neglectcases and the precarious fiscal ability of the state to manage them.Social workers were chosen to be the focus of the examination becauseof their central role in the agency.

The objective of the study was to evaluate, within the Department'spresent organizational structure, the role of social workers. Thisreport is a limited review of social workers' ability to deliverprofessionally acceptable services within the child protection system.It focuses on issues which directly relate to the performance of socialworkers and evaluates who they are, what they do, and what resourcesthey have available to protect children in Massachusetts from abuseand neglect. The report provides an objective commentary of areaswhere expansion or improvement is desirable. It is divided into twoparts.

PART IThe first part is divided into three sections. The first

section examines four distinctly related social work issues: education,training, supervision and compensation. The study concluded that:

• the Department's entrance requirements for social workers arecomparable to other states, and, the Department's gender basedcomposition is consistent with the gender based composition of theprofession. There is an absence of ethnic and racial minoritycandidates at public colleges and universities;

• the Department's social worker preservice training program isadequate;

• social workers generally receive adequate supervision. The newlyimplemented supervisory review tool appears to be a positive steptoward achieving accurate, accountable review of services andguaranteeing follow-up attention to cases; and,

• the Department's salary structure for social workers is comparableto other states.


The conclusions in the first section resulted 10 the followingrecommendations:

• The Department can expand the education and experiencerequirements for social workers to make positions more accessible.

- The Department must not only review its entrancerequirements, but also urge the Legislature to appropriatescholarship money to its state college and university system.

- The Department should begin a rigorous recruitmentprogram within the public high schools of the state,including an effort to attract or recruit ethnic and racialminority workers.

-- Recruitment should be combined with the opportunityto attend a state college or university BSW program, inreturn for a number of years of state service, available toall public high school students.

• Caseloads must reach a manageable level to free up time for socialworkers to attend continuing training and education seminars.

- The Department should maintain a strong commitmentto its training institute and continue to develop workshopthemes and social worker skills pertinent to the currentpredominant social issues.

- The Department should make journals available tosocial workers to keep them aware of current issues anddevelopments in the field.

- The Department must give social workers adequatenotice of policy changes which affect their performance andgive them time and training to coordinate and implementthe changes properly and effectively.

• The Department must comply with the social worker's unionagreement which requires that the supervisory ratio be 1:5supervisor-to-workers ratio in all area offices.

- The Department should continue to implement andmonitor the effectiveness of the current supervisory reviewto help control or maintain caseload growth and toguarantee effective, professional, accountable review ofcase decisions.

1992] SENATE - No. 1700 7

I

[1

5

• The Department should explore the causes of the apparent genderand minority based salary disparity which exists.

The second section examines current caseload standards andwhether those standards are being met? The study concluded that:

• social workers manage an excessive number of cases. Area officesare unable to meet their standards given the increasing demand forservices and the complex social issues Involved with each case.

The conclusion in the second section resulted in the followingrecommendation:

• The Department must achieve a reduction in social worker caseloadwithout affecting the quality of protective services.

The third section examines whether social workers have adequatein-home "family preservation" resources and out-of-home placementresources to perform effectively. Similarly, this section brieflyexamines the availability of resource support from other humanservices agencies. The study concluded that:

• social workers do not have adequate in-home "family preservation"resources to manage cases effectively;

• social workers do not have adequate out-of-home placementresources to manage cases effectively; and,

• social workers do not have adequate inter-agency resource support.

The conclusions in the third section resulted in the followingrecommendations:• The Department should deliberately invest additional resources in

preventive "family preservation" strategies rather than merelyredistributing scarce resources from other programs.

- The Department should concentrate its efforts oncoordinating and organizing community services.

- Community services should include a strong commitment to the entire day-care system, including the reasonablemaintenance of the income eligible day-care contractsystem, and the firm maintenance of the supportive and teenday-care contract systems.

- Community services should also include substanceabuse programs.


- Programs must be implemented for the purpose of improving social worker performance and strengthening the effort to preserve families, however, the Department should be realistic about its capacity to reduce the time it takes to successfully intervene in these demanding cases.

• The Department's financial commitment to out-of-home services should be maintained and used as effectively and efficiently as possible, including the real possibility of restructuring the entire out-of-home placement system.

• The Department should continue to monitor the effectiveness of its Family Life Centers and the commissioners of each agency should schedule a summit to formalize the relationship among and between agencies to encourage cooperation and integration at the service delivery level.

PART II

The second part of the report is divided into two sections. These recommendations expand upon the conclusions in the second and third sections of P ART I. The first section suggests some alternatives for the Department to explore to achieve a reduction in caseload without affecting the quality of protective services. The second section suggests an alternative out-of-home structure toward which the Department should consider moving. There is a need for change in these important areas.

• The Department should: a) modify Project Protect; b) rewrite the definition of "abuse and neglect"; c) modify the Department's intake responsibility; d) add social worker positions, and,

• The Department should initiate a new comprehensive community services strategy, including an effort to restructure and localize the out-of-home placement system by gradually investing placement resources into newly developed community group homes.

- The Governor and the Legislature must provide financial and administrative leadership and support and encourage municipalities to develop or renovate properties within their communities into group homes.

- This initiative should begin with a study of the Hingham South Shore Educational Collaborative program.

1992] SENATE - No. 1700 9

The Committee's narrow focus upon social workers confirmed thatthe base support of the organization is strong. But, as the reportacknowledges, in spite of its chosen focus, the review inevitablyexposed a broader need for both immediate and gradual change.

The challenge for the commonwealth is to recognize the changeswhich would best serve the interests of abused and neglected children.Careless redistribution of limited fiscal resources from one programto another without an effort to contain the responsibilities of theagency will seriously undermine the effectiveness of the agency. Thefailures of this redistribution strategy will become more pronouncedwithout change. This report identifies and suggests several areas,especially caseload reduction and out-of-home child placementfacilities, which deserve immediate attention. The next step is toimplement the changes swiftly and effectively in order to give childrenthe protection they expect and deserve. The significant performanceexpectations placed upon the Department by others will undoubtedlycontinue. Without change, including additional fiscal investment, thestate can expect continued criticism, further decline in agencyperformance and deteriorating service delivery.

1992] SENATE - No. 1700 11

TABLE OF CONTENTS

EXECUTIVE SUMMARY 5

INTRODUCTION 15Background 15

PART I

THE SOCIAL WORKER 18Education and Experience 18Training 21Supervision 22Compensation . . . . . . . . . . . . . . . . . 24

CASELOAD STANDARDS 25Current Standards 25Consequences 26

SOCIAL WORK RESOURCES 28Overview 28

Policy Identification 29Policy Implementation 30Policy Impact Upon Social Workers 30

In-home Resources 32Single Female Headed Households 32Substance Abusing Households 38

Out-of-home Resources 41Inter-agency Resource Support 43

PART II

CASELOAD REDUCTION 45Project Protect . 45Definitions of Abuse and Neglect 46Intake 47Number of Social Workers 50

OUT-OF-HOME PLACEMENTS 51Community Group Homes 52

CONCLUSION 54

AUDITEE'S RESPONSE 56

1992] SENATE - No. 1700

LIST OF CHARTS AND TABLES

13

CHART 1:CHILD ABUSE AND NEGLECT STATISTICS: 1983 - 1992 17

CHART 2:EMPLOYMENT STATISTICS 20

CHART 3:ABUSE AND NEGLECT AMONG MINORITY GROUPS .... 20

CHART 4:WORKFORCE SALARY COMPARISON 24

CHART 5:APPROPRIATION GAP 29

CHART 6:SUBSTANCE ABUSE 39

CHART 7:WEIGHTED CASELOADS 39

TABLE 1:RESOURCE DISTRIBUTION 29

TABLE 2:UNEMPLOYMENT AND POVERTY IMPACT 33

TABLE 3:DAY CARE CONTRACT SLOTS VS. VOUCHERS 34

1992] SENATE - No. 1700 15

INTRODUCTION

This report addresses the problem of child abuse and neglect. I Thecare of children in Massachusetts who are the victims of abuse andneglect depends primarily upon the effectiveness of the Departmentof Social Services. In particular, these victims depend upon the work,dedication and ability of its social workers. 2

This performance audit was conducted over the course of threemonths. The research involved six visits to the central office in Bostonand three visits to different area offices. Interviews were conductedwith five administrative officials from the Commissioner's office, threearea directors, fourteen supervisors, and twenty-one social workers.Data maintained by the Department and private organizations wasreviewed and studied.

The data contained in this report was provided by the Department,union representatives, social workers, public and private childadvocacy organizations, and public and private social servicesagencies of other states. This performance audit was conducted bythe Senate Post Audit and Oversight Bureau according to generallyaccepted governmental auditing standards.

Background

The Legislature created the Department of Social Services in Julyof 1978 and it began to function as an agency in July of 1980. Thelegislative mandate for the agency is broad and provides that "theDepartment shall provide and administer a comprehensive socialservice program."3

Similarly, the agency philosophy complements the mandate. "Thepolicy of the ... Department of Social Services is to strengthen andencourage family life so that every family can care for and protectits children."4 The Department must "make every reasonable effortto encourage and assist families to use all available resources tomaintain the family unit intact. However, for so long as a family

I For purposes of this report, terms shall be defined according to Department of Social Services Regulationsat 110 CMR § 2.00.

2 "Social worker" can be several different direct service positions at the Department. The direct servicepositions are Area Program Manager, Social Worker IV (Supervisor I), Social Worker III, Social Worker Iand Social Work Technician.

3MGl Ch. 188 § 2

4110 CMR § 1.01. see also MGl Ch. 119 § I.

16 SENATE- No. 1700 [September

cannot or does not provide the necessary amount of care andprotection for its children, the Department will intervene to protectthe right of children to sound health and normal physical and mentaldevelopment."5 The agency states that they are "concerned about[their] ability through [policy] initiatives, to achieve their aims and[to] reduce spending to the level of funds available. ''6 This concernof having to adjust the agency's responsibilities by limiting servicesand making difficult spending choices is one which the Governor andLegislature must be aware.

Social workers are instrumental to the agency's success. In thetwenty-six area offices located throughout the state, social workersare the foundation of the Department because they provide directcasework services to children and families.

Social workers service child abuse and neglect cases by followingdistinct regulatory guidelines. There are three ways a case can receiveservices: 1) a § 51A report of abuse and/ or neglect; 2) a voluntaryrequest for services; or, 3) a child in need of services (CHINS) casereferred from family court.

At "intake", the point at which the Department is made aware ofan abuse or neglect situation, social workers "screen" § 51A reportswithin twenty-four hours to determine the credibility of the report.If a § 51A report is "screened in", social workers initiate a twentyfour hour emergency investigation or ten calendar day non-emergencyinvestigation. After investigation, a § 51 A report is either "supported"or "unsupported". This is the point at which a voluntary request forservices or a CHINS referral would enter the system. Supported § 51 Areports, voluntary requests for services, and CHINS referrals eachreceive a forty-five day assessment. Depending on the need of theindividual child or family, an assessment can result in either noservices needed or on-going services. For cases requiring on-goingservices, a service plan is agreed upon within fifty-five days.Supervisory reviews, formerly called "Area Based Case Reviews"(ABCR), are scheduled to monitor cases as they progress until thereis a decision to close a case. ABCR is currently replaced by an alternative supervisory review method called SRT.

Slbid.

6Department of Social Services, FY'92 Management Performance Plan, Memorandum from CommissionerGerald W. Robinson to Secretary David P. Forsberg, Sept. 20,1991.

1992] SENATE - No. 1700 17

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I

Since 1983 the number of reported child abuse and neglect caseshas increased dramatically (see CHART 1). Four percent (3,113) ofthe total number of reported child abuse and neglect cases in 1990were screened in as emergency cases. In 1990, eighty-nine childrenmanaged by the Department died. Thirteen of these deaths occurredin cases which were managed by private agencies. This represents a6% increase over the number of deaths reported (eighty- four) in theprevIOUS year.

CHART 1. Child Abuse /Neglect StatisticsThousands

120 ,.-----------------------,

100

80

60

20

a1983 1984 1985 1986 1987 1988 1989 1990 1991 1992

_ Reported Cases ~ Investigated Cases 0 Supported Cases

Source:DSS Abuse/Neglect Statistics 199117992 OSS pro/ecteo reported cases statistics

There were 82,831 reported child abuse or neglect cases in 1990.Thirty percent or 24,848 were screened out. Of the 52,492 casesinvestigated, 23,871 or 45% were unsupported. The final number ofsupported cases for assessment and investigation was 28,621 or 34.5%of the total number of reported cases. The Department projected upto 97,000 reports in 1991 (actual number of reports equaled 88,748in 1991) and over 113,000 in 1992.

Although the demand for services continues to increase, the agencymust provide a "comprehensive social service program" supported byan "intact family" philosophy. The American Public WelfareAssociation's National Commission on Child Welfare and FamilyPreservation states three goals for child protection agencies: "to


protect children and youth who have suffered serious harm or are atrisk of suffering serious harm; to ensure that reasonable efforts aremade to safely maintain children in their own homes onceabuse/ neglect has been substantiated; and to provide permanency forchildren who are removed from their family. "7

This report examines whether the social workers in the commonwealth's primary child protection agency are capable of achievingthese goals.

PART I

THE SOCIAL WORKER

This section evaluates social worker education, traInIng,supervision and compensation. A social worker manages individualsand families in a variety of social environments. Social work as adiscipline, requires a delicate balance of compassion. Social workwithin the confines of a government agency can be compassionate,if the agency is sensitive and responsive to the extraordinary responsibilities and needs attached to it. Social work requires a completeunderstanding of the many issues which cases present. It requires arespect for the obligation to make careful, conscientious decisions,because social workers are agents of an agency with extensive powerto intervene in families' lives. The effort to preserve troubled familiesis encumbered with human fallibilities and requires the cooperationand coordination of a variety of professions. But, the ultimate responsibility and decision-making for the welfare of individuals and familiesfalls squarely upon the center of the organization, the social worker.

Education and Experience8

Comparatively, Maryland's mInImUm qualification for acaseworker is a college degree. Connecticut requires a Bachelor'sdegree and two years' case management and counseling experience.Several substitutions are allowed such as a Masters of Social Workor six years experience. Florida requires a bachelor's degree and oneyear of experience in a related field or a bachelor's degree in socialwork or a master's degree for a counselor. Florida's senior counselor

'National Commission on Child Welfare and Family Preservation, A Commitment to Change (Washington,D.C.: American Public Welfare Association, 1991), p. 16.

K For comparative analysis throughout this report, Maryland and Connecticut were chosen because theyrepresent similar northeastern states. Florida and Illinois were chosen because they represent similar industrialstates.

1992] SENATE - No. 1700 19

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position requires two years experience; a supervisor requires threeyears experience in addition to the bachelor's degree; and a publicassistance specialist requires a bachelor's degree. Illinois requires abachelor's degree in police science, law enforcement, criminal law,social services or related field; plus two years professional experiencein law enforcement or child welfare. .

Massachusetts requires two to four years of professional socialwork experience (depending on whether it is a social worker lor socialworker III position). A bachelors degree in social work can substitutefor some or all of the experience requirement. A bachelors degree insomething other than social work can substitute for up to one yearof the required experience.

Maryland conducted a study of qualifications and reported that"upon entry into the field of social work employees with formal socialwork education are superior to those without such education.However, after extensive training and experience on the job thoseemployees without social work education, on the average, are effectiveon social service tasks."9

The enrollment statistics of some area schools of social work revealthe current gender based enrollment trends in the profession.Bridgewater State, Westfield State and Salem State report that 93.4%,93.4% and 81.8% (78.4% in MSW program) respectively of thestudents enrolled in their BSW programs are female. Boston College,Boston University and Simmons report that 86%, 86.4% and 85.8%respectively of the students enrolled in their MSW program arefemale. An examination of gender statistics at the Department revealsthat nearly 75% of the Department is female and nearly 75% of socialworker I's and Ill's are female. This is consistent with the enrollmentstatistics of these area schools of social work.

An examination of minority statistics reveals that the Departmentcurrently employs nearly 22% minority employees and employs 23%minority social workers. The reported incidence of abuse and neglectreached 40.2% among minority groups in 1990 (see CHART 2; seeCHART 3).

9The Maryland Social Work Services Job Analysis and Personnel Qualifications Study, (Booz, Allen andHamilton Inc., January, 1987).

20

CHART 2.

SENATE - No. 1700

EMPLOYMENT STATISTICS

[September

PercentWorkforce Total Percent Women Minority

Department* 2894 74.8% 21.6%

Direct 2033 72.8% 22%Service**

SW I 1712 74.4% 23%& SW 111**

*EOHHS Summary of Agency**Affirmative Action Statistics as of November 16, 1991

CHART 3.

ABUSE AND NEGLECT AMONG MINORITY GROUPS

Sexual Physical EmotionalEthnicity Abuse Neelect Abuse Abuse Total

White 1,979 10,832 4,443 4,360 21,61471% 56% 57% 69% 59.8%

Minority 805 8,461 3,379 1,930 14,57529% 44% 43% 31% 40.2%

Total 2,784 19,293 7,822 6,290 36,189100% 100% 100% 100% 100%

Source - DSS Statistics

Whether the Department can sufficiently attract or recruit ethnicand racial minority social workers is an issue worthy of examination.

The state's public social work education system is educating fewminority students. Bridgewater State, Westfield State, and SalemState, for example, report 4.1 %, . 6.5% and 11.1% (7.2% MSWprogram) minority enrollment respectively in their BSW programs.Whereas, a private MSW program, such as the ones offered by BostonCollege, Boston University and Simmons, report 10.1% (9.7% parttime), 24.9% and 7.2% (11.1% BSW program) minority enrollmentrespectively. It is clear that the public colleges and universities need

1992] SENATE - No. 1700 21

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to attract more minority social workers. These groups need access tothese positions and opportunities. Often, families with strong ethnicor racial beliefs benefit from having social workers who understandcultural barriers and can break down the barriers and facilitatecommunication.

CONCLUSION: The Department's entrance requirements for socialworkers are comparable to other states, and, the Department's genderbased composition is consistent with the gender based compositionof the profession. There is an absence of ethnic and racial minoritycandidates at public colleges and universities.

RECOMMENDATION: The Department can expand the educationand experience requirements for social workers to make positionsmore accessible. The Department must not only review its entrancerequirements, but also urge the Legislature to appropriate scholarshipmoney to its state college and university system and begin a rigorousrecruitment program within the public high schools of the state,including an effort to attract or recruit ethnic and racial minorityworkers. The opportunity to attend a state college or university BSWprogram in return for a number of years of state service is a programwhich should be made available to all public high school students.

Training

The responsibility to train social workers falls proportionately uponboth the area office to which they are assigned and the central office.The pre-service training program lasts fifteen days. Case assignmentbegins on day ten. Social workers have the opportunity to continueeducation through paid in-service seminars sponsored by theDepartment. Days fourteen and fifteen mandate two training instituteworkshops. Additional seminars are optional and cover a wide varietyof social topics. The burden to attend is on the social worker althoughsupervisors can require a social worker to attend a workshop if it isneeded. Given the education and experience requirements, the lengthof the pre-service training is adequate, but, this is not to say that thetraining program should not undergo periodic self-examination andself-criticism to avoid serious errors which affect children's well-being.Part of this process necessarily involves reinforcing principles ofcommon sense.


The results of the trammg institute workshop program areencouraging. For example, in FY91, the Department reports thatninety-nine social work training institute events attracted 2,230participants. Supervisors express disappointment that not enoughsocial workers are able to make time to attend these seminars. Socialworkers share this disappointment. But, there is an overall benefit ofhaving these workshops available to social workers. Ifcaseloads reacha manageable level, more social workers can benefit from continuingtraining and education.

Another area in which social workers expressed some concern isthe area of policy changes within the Department. When theDepartment develops and issues policy changes, it must give socialworkers notice and training to implement the changes properly andeffectively. There must be coordination between the administrationwhich issues the policies and the social workers who must carry themout.

CONCLUSION: The Department's social worker preservice trainingprogram is adequate.

RECOMMENDATION:Caseloads must reach a manageable levelto free up time for social workers to attend continuing training andeducation seminars. The Department should maintain a strongcommitment to its training institute and continue to developworkshop themes and social worker skills pertinent to the currentpredominant social issues. The Department should make journalssuch as Social Casework: The Journal ojContemporary Social Work;Social Work bv NASW; Child Abuse and Neglect; or, Journal ofWomen and Social Work available to social workers to keep themaware ofcurrent issues and developments in the field. The Departmentmust give social workers adequate notice of policy changes whichaffect their performance and give them time and training to coordinateand implement the changes properly and effectively.

Supervision

Supervision is a very critical issue, and supervisors play a verycritical role for an effective Department. Supervisors control the casemanagement process by assigning cases to social workers. But mostimportantly, supervisors assure that the critical decisions made bysocial workers are responsible ones. The social worker's union

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agreement requires that the supervisory ratio be 1:5 supervisor-toworkers ratio, and this ratio, when maintained, is a favorable one.Supervisors must possess the inter-personal skills necessary to relateto social workers effectively and maintain consistency in caseassignment. They must also possess the professional skills necessaryto make responsible and accountable judgments.

The Department implemented an experimental case review systemcalled Supervisory Review Tool (SRT) in place of Area Based CaseReview (ABCR). ABCR was a six-month review of nonplacementcases and operated in conjunction with the Foster CareReview (FCR) to assure supervisor's review of all cases. SRT, on theother hand, is a quarterly review of cases (non-placement cases onlyin 24 area offices in conjunction with FCR, and, all cases in pilotprograms in 2 area offices) and purports to relieve some social workerresponsibility by placing the burden of review upon unit supervisors.Supervisors focus case objectives and set target closing dates. SRTgets mixed reviews from supervisors primarily because it is viewedas imposing a quota system on cases which need individual attentionand treatment. In other words, while cases will receive two more yearlyreviews, it is not necessarily guaranteed that, as a result of suchperiodic review, cases will be closed any sooner nor that caseloadswill decrease. Generally, however, it is an effective program to achievea one-time reduction of caseload, while its overall effectiveness as acaseload maintenance program is yet to be determined. The FieldsCorner caseload, since the implementation of SRT, has been reducedto a somewhat manageable level. Some social workers were able toreduce caseload from twenty-six cases to as low as fourteen cases.Now, because the review has different impacts, areas must addressthe problem of redistributing the existing caseload among socialworkers since some continue to manage over twenty-five cases.

Supervisory duties and responsibilities include individual andfamily consultation, case review, evaluations and service planning.Field observations reveal that they generally meet formally with socialworkers once a week, and also informally to address problems andemergencies. Only one of the three area offices examined had asupervisory ratio greater than 1:5.

CONCLUSION: Social workers generally receive adequatesupervision. The newly implemented supervisory review tool appears

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1992] SENATE - No. 1700 23


to be a positive step toward achieving accurate, accountable reviewof services and guaranteeing follow-up attention to cases.

RECOMMENDATION: The Department must comply with thesocial worker's union agreement which requires that the supervisoryratio be 1:5 supervisor-to-worker ratio in all area offices. TheDepartment should continue to implement and monitor theeffectiveness of the current supervisory review to help control ormaintain caseload growth and to guarantee effective, professional,accountable review of case decisions.

Compensation

Comparatively, Maryland caseworkers earn between $17,952 and$31,628 without a masters degree or experience. Caseworkers with amasters degree earn between $22,360 and $34,075 with no experiencenecessary. In Connecticut, social workers earn between $33,084 and$40,317. In Florida, counselors earn between $17,412 and $30,374.In Illinois, child protection· workers earn between $25,944 and$29,628. In Massachusetts, social workers earn between $20,737 and$31,788.

A review of the Department's average salary levels reveals that theaverage salary at the Department is $28,979. The average salary forthe Department's professionals is $28,667. Although the Departmentemploys nearly 75% female employees and 22% minority employees,female and minority average salaries fall below the overall averagesalary and the average salary of males employed by the Department.Social worker I's and social worker Ill's are nearly 75% female and23% minority, yet their salaries also fall below the average salaryDepartment wide and the average salary of males in their professionalcategory (see CHART 2; see CHART 4).

CHART 4.

WORKFORCE SALARY COMPARISON

Total Avg. Male Avg. Female Avg. Minority.Workforce Salary Salary Avg. Salary Avg. Salary

Department $28,979 $32,720 $27,717 $28,603

Professionals* $28,667 $30,621 $27,945 $28,969

*Includes SW I and SW III positionsSource: DSS PMIS65F

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1992] SENATE - No. 1700 25

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There may be a variety of causes of this result. This report doesnot examine the causes of this salary disparity, however, it doespresent the issue for discussion and examination.

CONCLUSION: The Department's salary structure for socialworkers is comparable to other states.

RECOMMENDATION: The Department should explore the causesof the apparent gender and minority based salary disparity whichexists.

CASELOADSTANDARDS

The first section examined whether social workers are professionally capable of managing child abuse and neglect cases. Thissection examines current caseload standards and whether thosestandards are being met.

Current StandardsThe Department must comply with several caseload standards.

First, the Department accepted standards set in a four-year settlementagreement with the Massachusetts Committee for Children and Youth(MCCY), a private non-profit child advocacy agency which filed aclass action lawsuit in 1979 to improve services provided by the state.The standards set in the settlement were 1:12 worker-to-cases ratiofor investigations and 1: 18 worker-to-cases ratio for on-going cases.A subsequent report on compliance issued by MCCY in 1988illustrated that the Department was not in compliance. 10

Second, the Department must comply with the federal courtstandard set forth in Lynch v. King, 550 F. Supp. 325 (1982). Thiscase established a standard of 1:20 worker-to-"generic" cases ratio.

Third, the Department must comply with the social workers unionarbitration agreement. Local 509 of Service Employees InternationalUnion (SEIU) negotiated an agreement with the Department. Thestandards of that agreement are 1: 12 worker-to-cases ratio for investigations (weighted at 1.5 points each), 1: 12 worker-to-cases ratio forassessment (weighted at 1.5 points each) and 1:18 worker-to-cases for

IOMCCY is currently contributing to a report by the Special Committee on Family Support and the ChildWelfare System. The report is worthy of examination because it invokes discussion and offers an additionalperspective on many of the issues raised in this report.


on-going cases (weighted at I point each).11 The standard forsupervision is a 1:5 supervisor-to-workers ratio.

Because the Department violated the agreement, an arbitrationaward dated March 9, 1989 indicated that the Department must"prepare a budget request for additional social worker I and socialworker III positions in sufficient number to comply with the weightedworkload standard ... The number of positions requested was to beof sufficient magnitude so that no social worker I or III would havemore than twenty-two (22) weighted workload points fortwo (2) consecutive months. "12 The Department is obligated also to"prepare budget requests for additional social worker I and socialworker III positions when relief has not been provided for positionswith more than twenty-two (22) weighted workload points fortwo (2) consecutive months. "13 The Department failed to make suchrequests and caseloads continued to exceed weighted workloadstandards until February 1990. Supplemental Agreement Qstates thatwhen available resources are insufficient to comply with theagreement, and, when relief has not been provided and workloadscontinue to exceed the limits, the Department is ordered to makequarterly requests to EOHHS for additional social worker positions.14

One such recent request was for 309 additional social work staffpositions.

Consequences

In June 1990, there were 96.5 social workers with weightedworkloads greater than twenty-two for two reporting months. Sincethen, the numbers have ranged between 117 workers and 207 workersover the limit of twenty-two weighted cases for two consecutivemonths. The number of workers with weighted caseloads greater thantwenty for one reporting month is significantly higher. During theperiod from September 1990 through June 1992, the number of social

\lEach and every case is uniquely different and requires a different management approach. For example,some cases may involve one child and another case may involve five or six children and multiple abusesof substances. A "weighted" caseload system is a method of measuring the maximum number of cases whichcan be managed by a social worker at one time. To derive a social worker's weighted caseload, multiplythe actual number of "screening" or "assessment" cases by 1.5 or multiply the number of "on-going" casesbyone.

12 Paragraph four of Arbitration Award #883 (March 9, 1989).

13 Paragraph five of Arbitration Award #883 (March 9, 1989).

14SEIU Agreement, December 1990, Supplemental Agreement Q.

er1992] SENATE - No. 1700 27

)r

Instal:d

'eIro11lS

IrhdItese4

:lese1

1

workers with weighted caseloads greater than twenty for one reportingmonth ranged between 525 and 731. The Boston area offices tend tohave the highest number of social workers over the standards,although each of the other areas have significant numbers over thestandards as well. The only evidence of caseload shifting to conformto standards occurred in Fields Corner as explained earlier.

High caseloads prevent social workers from meeting mandatorytime restraints and prevent timely review. For example, Departmentreports for April, May and June of 1991 reveal that only 25% to 30%of assessments were completed. statewide within forty-five days ofinitial contact as required. One day emergency and ten day nonemergency investigations resultyd in a much higher compliance rateof 93% to 95% statewide for the same time period. Mandatory timerestraints are important because children remain at risk when longperiods of time lapse between periods of intervention and/ or management.

Three area visits also revealed that each area manages too manycases according to each of these standards.

In Fall River, social workers routinely handle eighteen to twentytwo on-going case assignments. Department statistics on twelvemonth caseload/workload illustrate that this office employs anaverage of forty-three FTEs and managed an average of 18.32 cases(20.50 weighted). There are five social workers per unit supervisor.

In Weymouth, social workers routinely handle eighteen to twentyone on-going case assignments. Department statistics on twelvemonth caseload/workload illustrate that this office employs anaverage of forty-nine FTEs and managed an average of 17.25 cases(18.82 weighted). There are five social workers per unit supervisor.

In the Boston office at Fields Corner, social workers have beenroutinely handling an excessive number of cases for at least one year.Social workers handle up to twenty-six on-going case assignments(and as many as fifteen investigations). Department statistics ontwelve month caseload/ workload illustrate that this office employsan average of fifty-one FTEs and managed an average of 20.50 cases(22.34 weighted). There are six social workers per unit supervisor insome instances.

CONCLUSION: Social workers manage an excessive number ofcases. Area offices are unable to meet their standards given the


increasing demand for services and the complex social issues involvedwith each case.

RECOMMENDATION: The Department must achieve a reductionin social worker caseload without affecting the quality of protectiveservices.

SOCIAL WORK RESOURCES

While most social workers are capable of managing a "standard"caseload, this section examines whether social workers have adequatein-home "family preservation" resources and out-of-home placementresources to perform effectively. Similarly, this section examines theavailability of resource support from other human services agencies.

Overview

To begin this evaluation of whether social workers possess adequateresources, it is first necessary to briefly examine the agency organizational structure in which they perform and the policies which theymust support. In 1991, the Department's organizational structurechanged. Reflecting the views of new leadership and inadequatefunding, the Department reorganized and identified "familypreservation" as its policy focus. 15 The Department consolidated intoa central office and twenty-six area offices.

The central office is responsible for policy and procedure management and administration. The twenty-six area offices are responsiblefor implementing the policies and procedures through the delivery ofservices by area direct service staff. Essentially, each area office hasa great deal of autonomy. However, an inherent characteristic of thiscentralized structure is that each area office demands clear guidance,direction and support from the central administrative office. Becausethe organizational structure itself is new, measuring its effectivenessnow would be premature. However, those who administer within thenew structure must establish clear and coordinated policy or else beaccountable for wrong decisions which affect the lives of children andfamilies.

Policy and fiscal management have a dramatic effect upon socialworker decision-making and performance. Because the Department

I~ Department of Social Services, FY'92 Management Performance Plan, Memorandum from Commissioner Gerald W. Robinson to Secretary David P. Forsberg, Sept. 20,1991.

!>er 1992] SENATE - No. 1700 29

ved

ion:ive

closely integrates its policy goals with its fiscal resources, the processof identifying and implementing policy goals should be reviewed aswell as its impact upon social workers.

Policy Identification

According to the Department, it had $404 million available to itin FY92. These dollars were divided among five "programs".

"It is $2.2 million less than the Department's expenditure level inFY91, and $1.3 million less than the Department's expenditure levelin FY90. Adjusting for a four year inflation ratio of 4%, the numberis slightly below the Department's FY88 spending level. "16 The

CHARTS

Appropriation Gap

7%$ 30.lm$404.0m

Thousands Millions100 500

I

I80 r 400

III

60 c- 300

I40 f- 200

I20 r 100

0 0

TABLE 1.

__-=-P-=-R:.....::O---=G=--=R~A-=-M~S__ RESOURCES % OF RESOURCESOut-of-Home Services $185.3m 46%Case Management Service $ 69.4m 17%Family Preservation Services $ 41.7m 10%Day-Care Services $ 77.5m 19%Administrative Support

Services

ce,Ise

,hebend

gebleof

lashis

~ss

rd"lateenttheles.

atemIleyLIreate.ilylto

ial~nt

FY83 FY84 FY85 FY86 FY87 FY88 FY89 FY90 FY91 FY92.._---

- Reported Cases _ Appropriation

1992 Estimated Number of Reported Cases

Source: ess FY92 Management Performance pian

is-16 Department of Social Services, FY'92 Management Performance Plan, Overview, p. 6.

30 SENATE - No. 1700 rSeptember

19Department projects that the Legislature will appropriate up to $403.7million in FY93 (actual appropriation equals between $409.5 millionto $416.4 million in FY93) (see CHART 5). As a result, the appropriation gap, which is the disparity between the number of reportedcases and the appropriation to manage them, has widened.

Because of this growing appropriation gap, and in an effort tocontrol costs, the Department identified the reduction of its caseloadas its primary responsibility and policy goal.

The Department estimated the number of cases it couldprofessionally manage with $404 million. A "case managementinitiative", including the implementation of the new supervisoryreview process, began. The intent of the initiative was to controlcaseload growth. "The management challenge which faces theDepartment for the foreseeable future is how in the face of these[caseload] statistics and their core causes can its financial structurebe redirected away from a heavily reactive investment in out-of-homeplacements to an at least modest pro-active investment in a familypreservation and reunification strategy. "17 This statement, perhapsmore than any other, exemplifies the dilemma and focus of the agency.The risk, inherent in this statement, however, is a carelessredistribution oflimited resources from one program to another. Mereredistribution without an effort to control the responsibilities of theagency undermines the effectiveness of one program for the benefitof another.

Policy Implementation

Having identified "family preservation" as its objective and thereduction of its caseload as its policy goal, the Department scrutinizedout-of-home placement expenditures.

To control the growth in out-of-home placements, the Departmentimplemented "area spending levels" for group care and foster care with"hard edit" to control authorization of services. 18 In theory, theDepartment appropriated enough fiscal resources, with respect to casemanagement, to meet I) the existing privately contracted services and2) expected group care and foster care services. The methodology used

17 Department of Social Services, FY'92 Management Performance Plan, Overview, p. 3.

18 Department of Social Services, FY'92 Management Performance Plan, Out-oj-home Placements, criticalcomment p. 8 of 15.

tocaUI

reefgISIdeth

dere

"c~

$wclalTf~

s(Sl"j

sen

p

n\\

cor

(Ju

Der

3.71992] SENATE - No. 1700 31

onro:ed

tolad

lId~nt

)ryro1the~se

He

meilyLpS

:y.~ss

~re

hefit

heed

ntthheseld~d

to appropriate these resources was both historical usage and estimatedcaseload. The Department stated that it "conduct[s] contractunderutilization, reducing obligations to expenditure levels to allowreallocation of resources. "19 In other words, the Departmenteffectively limited the funding of area offices in an effort to con,straingroup care and foster care spending to allow for spending in otherspending categories. However, the danger of creatiIig "a servicedelivery system that is driven by [its] funding processes rather thanthe needs of children and families", exists. 20

By constraining group care and foster care spending, placementdecisions weigh more heavily in favor of "family preservation",reserving group care and foster care for only the most needy cases.With fewer fiscal resources available for placement, areas mustexamine cases more carefully and scrutinize the choice between groupcare or in-home services. Fiscal policy determines what resources areavailable rather than client and social worker needs.

For example, if an area projects a need of $3 million and is allocated$1.5 million, an area must make difficult choices when decidingwhether to place a child in group care or foster care or maintain achild in the home. Placing too many children 'too early in a fiscal yearand depleting fiscal resources is an immediate threat to area directors.The threat of maintaining children in their home without the necessaryfamily treatment resources to prevent abuse is a far greater threat forsocial workers and the children they protect. The policy of constrictingspending on out-of-home care to allow for increased spending on"family preservation" services may have an undesirable impact uponsocial workers' ability to perform effectively and therefore should bereviewed.

Policy Impact Upon Social Workers

Growing caseloads, budget constraints and diminished resourcesclearly impact service delivery. Both in-home and out-of-homeresources are fundamental, not only to the performance of socialworkers, but also to the success of the agency. "The in-home supports

19 Department of Social Services, FY'92 Management Performance Plan, Family Preservation, criticalcomment p. 6 of 7.

20 Susan D. Robinson, NCSL Putting the Pieces Together: Survey 0/ State Systems/or Children in Crisis(July, 1990), p. 19.


which are available to case managers have eroded by 30% over thepast three years, largely to meet budget reduction targets and to fundout-of-home placements. This has been a self-defeating short termpolicy. "21 The Department acknowledges that redistribution has beenan ineffective policy. The Governor and the Legislature must alsoacknowledge this failure.

Once again, the Department must examine and evaluate its overallfiscal allocation and determine which programs would most benefitfrom additional resources in the effort to achieve its goal of "familypreservation".

In-home Resources

The Department is within its management prerogative to pursuean initiative called "family preservation" and to adopt fiscal strategiesdesigned to implement this initiative. But the decision to pursue"family preservation" is not beyond review and in the course of thateffort it may be useful to examine this decision in the context ofexamining the kinds of families the Department is trying to preserve.

The majority of supported cases involve neglect (19,293 in 1990)(see CHART 3), [physical abuse (7,822), emotional maltreatment(6,290) and sexual abuse (2,784) account for other forms ofmaltreatment]. Because the Department recently identified thenumber of single female headed households and substance abuse astwo fundamental and predominant factors contributing to child abuseand neglect, it may be particularly useful to examine the supportresources available for social workers in an effort to meet their goalof "family preservation" with respect to these two issues.

Single Female Headed Households

The Department indicates that socio-economic factors such asunemployment and poverty contribute to increased incidence of abuseand neglect. It has studied and collected information showing thatrelationship (see Table 2).

The first major factor leading to a decline in socio-economic statusand an increase in caseload growth is the number of single femaleheaded households. The Department recognized the potential effects

21 Department of Social Services, FY'92 Management Performance Plan, Family Preservation, criticalcomment p. I of 7.

er 1992] SENATE - No. 1700 33

:hendrm:enlso

all:fitily

uelesue.atof'e.0)ntofle

assertal

is

IS

lets

upon child development and, apparently in response, dedicated 19%of its FY92 budget to day-care services. This allocation provided over4,000 supportive contracted day-care slots which are critical to a socialworker's efforts to keep a family together and to protect children frompotential abuse or neglect as a result of economic strain.22 However,this budget reflected a loss of 2,000 income eligible day-care slots. TheDepartment estimates that 40% to 60% of income eligible consumerslost day-care services altogether. 23 The Department's commitment tomanaging the issue of day-care services is important. Currently,EOHHS is cooperating with the Department to develop a strategyto manage day-care programs more effectively, including theintroduction of the open and competitive bid process. So far, thismanagement strategy, as evidenced for example, by the Governor'srecent FY93 budget proposal, presents many difficulties.

TABLE 2.

City/Town per capita Neglect Unemploy. per1990 reporting reporting rate capita

rate rate incomeChelsea 48 598 8.8 $9728New Bedford 33 508 11.1 $9325Lawrence 140 499 11.5 $9451Holyoke 89 490 7.8 $10870N.Adams 36 458 9.0 $9662

STATEWIDE 312 262 6.0 $14389

Cambridge 380 252 3.8 $15613Quincy 337 252 5.8 $14487Beverly 152 250 4.3 $15657Medford 268 214 5.2 $13675Framingham 347 187 4.8 $17599

The Governor's proposal attempts to replace nearly half of theincome eligible contracted slots at the Department with a certificate

22 Contracted slots are slots available at a particular day-care center. The Department purchases, throughopen bid, a specific number of day-care slots. Voucher slots, on the other hand, require a voucher or certificate from the Department. Families present the voucher/certificate to a day-care center and the Departmentreimburses the day-care center for care.

23 Department of Social Services, FY'92 Management Performance Plan, Day Care, critical commentp. 3 of 3.

19~


TABLE 3.

* Proposed '93 slots are APPROXIMATIONS•• Voucher information for '93 includes DPW MASSJOBS vouchersand DSS certificate program.

program administered and managed by child care resource agenciescontracted by the Department of Public Welfare (DPW). Althoughthe proposal maintains the current number of supportive and teenday-care services slots, it increases the number of voucher slotsavailable through the MASSJOBS program at DPW from 6,500 toapproximately 8,000, and decreases the number of contract slotsavailable through this program to zero. The proposal also addsapproximately 5,800 income eligible vouchers! certificates at theDepartment, and, decreases the number of income eligible contractslots available through the Department from approximately 10,800to approximately 5,800. A regional analysis of the proposed changesindicates that every region of the state has been significantly affected.

Number of Contract Slots·

01

thfoara,

mW

pIdebeflepIc(v(frulfi)beIn

cost:We

eliFisysutotoccIS4

ar01

thdtth5~

Proposed '93

15471228

105

16201405

77

113384389

1599727104

Proposed '93

13,802

FY92

27271134

105

30181415

77

2082740

89

3021716104

FY92

6,500

FY91

31191135105

35221417

77

2448742

89

3660716104

FY91

8,085

FY90

32831135

109

37201430

86

2551746

89

407370890

FY90

11,604

Number of Voucher Slots··

Inc. E1ig.SupportiveTeen

Inc. E1ig.SupportiveTeen

Inc. Elig.SupportiveTeen

Inc. Elig.SupportiveTeen

FY89

12,027

Boston

Region

Western

Northeast

Southeast

Statewide

)er

:les Lgh ~en

ots to

ots ids the act :00 ges ed.

93

J3

!rs

1992] SENATE - No. 1700 35

A proposal such as this is a systematic erosion of the income eligible contracted day-care system. Most importantly, it threatens the stability of the existing day-care system and will indirectly affect social workers. Department statistics present the changes well.

There are several reasons why the drastic red uction of income eligible contracted day-care slots should be viewed with skepticism. First, while the recent history of the voucher system and the contract system operating together indicates that each system is individually successful, the two systems, when properly funded and working together, can enjoy success as well. However, the task becomes how to provide sufficient protection within each system and to provide continuity of care between them. In particular, it is important to isolate the distribution percentage of income eligible contracted slots and voucher/certificate slots among DPW and the Department in order to determine which combination of the two systems will yield the best results for the children and families for whom the system is designed to service. A review of the distribution since 1989 reveals that the distribution remained favorable toward contracted slots from 53% in FY89 to 62% in FY92. However, under the current proposal only 30% are reserved for contracted slots. This radical departure from the distribution scheme of recent' history will be extremely difficult for day-care providers who rely upon the contract system to absorb, and this failure will ultimately affect the stability of provider services available to children and their families.

Second, service providers offer day-care services to low- and moderate-income families. The small- and moderate-size providers who service this population rely upon the assistance of the state to provide a reasonable financial base upon which the business can depend. The contracted slots provide that assistance because they can be used as security for business loans or otherwise, to meet the cash flow needs of these undercapitalized providers. Most of these providers are situated in high popUlation communities and in communities which are economically depressed. Although the voucher / certificate system is intended to provide families with more freedom to chose a day-care facility, the day-care providers who rely upon income eligible contracted slots, and who do not have the financial base to support the day to day operations of the facility, will be forced to close down. The most critical and vulnerable communities in the state will suffer the most. The effect of allowing these small-


and moderate-size providers to dose down will result in fewer choicesbetween providers, and, in many urban communities, no choice at all.

The Governor's proposal is weighted with unpredictability andunreliability and threatens to close many service providers. This ishardly the expected result from a system originally designed toenhance choice. To resolve this issue, the request for proposal andopen and competitive procurement process is critical. Once theGovernor and the Legislature have agreed upon the funding for areasonable distribution between income eligible contracts and thevoucher/ certificate systems, a distribution which maintains a firmcontractual base for day-care providers, the discussion should turnto what is an appropriate distribution among and between existingproviders in each community in the state. An essential part of thisdecision is that small- and moderate-size day-care providers in lowand moderate-income communities, as part of the open andcompetitive bid process, be guaranteed up to 25% of the availablecontracted slots. This is critical because, as stated earlier, small- andmoderate-size providers in low- and moderate-income communities,not only provide a valuable service to their particular community, butthey also need the secure financial base to remain available. A fiscalpolicy that disregards this need .risks the loss of valuable day-careresources. And if there are fewer providers in these communities, itwill have an effect upon the stability of the families who rely uponthem for care.

While this report is not an in-depth study of day-care issues, it isincluded because it is one of the issues at the Department whichnegatively affects social workers. As such, it is the final reason whythe drastic reduction of contracted day-care slots should be viewedwith skepticism. As stated, a major concern for social workers is beingable to manage abuse and neglect cases with resources that offerchildren protection. Day-care providers with a special awareness ofthe particular needs of abused children are part of that resource baseand the. availability of supportive contracted day-care services iscritical in this regard.24 Similarly, day-care providers with a specialawareness of the particular needs of poor families are an indirect partof social workers' resource base. Any modification of income eligible

24 One further issue worthy of close examination is the impact which premature termination of supportiveday-care services could have upon families and social worker's efforts to preserve them. The Department'scurrent policy is to automatically terminate supportive day-care services when there has not been a § 5lAreport within twelve months.

tber 1992] SENATE - No. 1700 37

)Icestall.and

lIS IS

J toandthe

or athe

firmturn:tingthis

lowandableandties,but

.scalcare:s, itpon

it isl1ichwhywed~mg

lffers of)ases IS

:cialJartible

tivent's;IA

day-care services may have an indirect effect upon social workers. Theprinciple reason is because the providers who have this specialawareness will not have a sufficient contract base to assure theirsurvival and the burden to care for these families will eventuallybecome a part of the overall burden upon the Department and itssocial workers.

Income eligible day-care services offer single mothers and familieswho rely upon two incomes, a resource to allow them to work ratherthan burden the welfare system. The Governor's proposalcontemplates that consumers will have unrestricted access to thissystem. However, individuals can only take advantage of rehabilitation and retraining opportunities if there are day-care servicesavailable to them. The most illustrative example of the dramatic effectsuch a change would have in Massachusetts is a pilot programimplemented in Philadelphia, Pennsylvania. "A similarly precipitouschangeover to vouchers in the state of Pennsylvania is havingdisastrous results ... A 12 county pilot changeover has resulted in thenear closing of several centers in inner city neighborhoods, less accessto care, and 'a bureaucracy that is out of control. '... Six months afterthe new voucher system took effect, 'the Welfare Department realizedits policy had endangered the 21 old providers in poor neighborhoods'who had depended on state subsidies ... and the number of childrenenrolled in the system fell by 4.4%"25

The effect of eliminating nearly half of the income eligiblecontracted slots may result in the closing of many providers incommunities which require a response to this issue the most.Dependent families will eventually be forced to forego theopportunities of employment and self-reliance in favor of stayinghome. This decision can only lead to further unemployment andpoverty, and, abuse and neglect as a result of economic strain. In somecommunities of the state, where unemployment has consistentlyreached 115% of the rate of unemployment statewide, this is aquestionable risk. Without sufficient day-care providers incommunities, families will become more vulnerable. The cases ofneglect and abuse from economic strain will rise and this rise willincrease the caseloads of social workers.

2~ Donna Southwell, "Pennsylvania daycare disaster provides lesson in caution," Stote House Wotch,12 May 1992.

38 SENATE - No. 1700 [September 19

Social workers deserve strong resource support from within theirown agency to manage cases of abuse and neglect. The supportivecontract system of day-care services provides critical stability to aresource which in turn is critical to achieve the fundamental goal of"family preservation". The income eligible contract system isimportant too because it helps to provide predictable cash flow forsmall- and moderate-providers. Among the questions which remainare whether there are adequate protections in each payment systemto provide continuity of care between them, and what is the appropriate balance between the two systems? Without substantive evidenceof answers to each of these questions, and the effects uponcommunities and caseload responsibilities, the Governor and theLegislature should negotiate a reasonable balance of all incomeeligible contracted and voucher/ certificate slots among DPW and theDepartment to assure the foundation of the system as well as graduallymake it a progressive one.

Substance Abusing Households

The Department also identified substance abuse as a contributorto increased incidence of abuse and neglect and the deterioration offamilies. The Department estimates that 2/3 of all cases involvesubstance use or abuse (see CHART 6). The correlation between theincrease in substance abuse and the increase of abuse and neglect andfamily violence, led the Department to implement "Project Protect"."Project Protect" is a policy directive designed to protect children andassist families in all cases where substance abuse or family violenceexist. The project was implemented in January 1990, but it has hada negative effect upon caseload growth and it also has not beensuccessful in promoting "family preservation" (see CHART 7).

CIl

CH

thsupr

)er1992] SENATE ~ No. 1700 39

Substance AbuseStatewide vs. Boston

Alcohol Cocaine Heroin Other Drug NoneAllo

PERCENT OF ALL CASES70~,---------------------

I60 r

10

30

20

50

40

CHART 6.

elrlve) aofIS

for

~m

.un

rolceon:heme:helly

_ Statewide _ Boston

Source: OSS Substance Abuse and Family Violence. Jan. 1990

:orof

lvehendt".ndlceaden

CHART 7. Weighted CaseloadsWeighted Caseload (Thousands)

30

1

25 r

20 lI

:: ~5rOL

1988 1989 1990 1991

- February _ May 0 August _ November

Source: Department of Social Services Statistics

This lack of visible success mayor may not be related to the factthat the Department does not spend. its budgeted fiscal resources onsubstance abuse treatment programs. The Department, instead,provides substance abuse education, counselling, and behavior


modification input. Similarly, self-help community resources (AA,Narcotics Anonymous, Cocaine Anonymous, etc.) are oftenrecommended. The Department depends upon the substance abusetreatment services contracted by the Department of Public Health(DPH). The prevailing view about the DPH providers is that theyare often difficult to obtain because of the high demand. In FY90,FY91 and FY92, Massachusetts appropriated $38.8m, $31.6m and$27.8m respectively to DPH Bureau of Substance Abuse Services. 26

In light of this history, it is questionable whether the state and theDepartment can expect that this allocation, in addition to retainedrevenue and federal accounts, is enough to address what has beenexplicitly labeled as one of the most prevalent issues contributing tochild abuse and neglect.

A comprehensive fiscal commitment to one state agency, either theDepartment or DPH, should be a critical first step to stabilizing andcontrolling abuse and neglect as a result of substance abuse, but itis not the entire answer. Doubt exists about whether simply increasingfiscal resources for treatment programs and educational preventionprograms, will, in the long run, reduce caseloads and enhance "familypreservation". Studies indicate that results of outpatient drug freeprograms are less than encouraging. "Of those being treated forcocaine use, only 25.4% remained in treatment for 120 days prior todischarge; and only 26% completed treatment; less than 40% wereproductive at discharge; and only 26% were drug free at discharge. ''27

These modest results raise the issues of whether additional investmentin substance abuse programs is effective. More research still must bedone to determine whether additional investment in substance abuseprograms is an effective means to acheive "family preservation".Because questions remain in this area, the Department must alsodetermine whether increased investment in a "family preservation"strategy is enough to manage the caseload and placement difficultieswhich the Department is experiencing.

A "famiiy preservation" strategy is not merely an investment inservices such as day-care or substance abuse programs. Rather, a"family preservation" strategy must include such fundamental servicessuch as family planning, adult education centers, literacy programs,

26 Substance abuse appropriations do not include $l.3m, $1:05m and $230,832 in retained revenue in FY90,FY91 and FY92 respectively.

27 Study of the Commonwealth of Pennsylvania Drug Treatment Programs, 1991.

)er

~A,

ten use LIth ley 90, md S.26

the led ~en

;to

the md t it mg ion lily ree for ·to ere ''27

ent . be use n": Llso )n" ties

:m ., a .ces ms,

'90,

1992] SENATE - No. 1700 41

medical clinic services, food pantries, shelters, arts and athletic programs, job skills training programs and support groups. These are fundamental services which, in addition to day-care and substance abuse programs, communities can establish through schools, hospitals and churches to invest in a comprehensive strategy designed to manage child abuse and neglect.

CONCLUSION: Social workers do not have adequate in-home "family preservation" resources to manage cases effectively.

RECOMMENDATION: The Department should deliberately invest additional resources in preventive "family preservation" strategies rather than merely redistributing scarce resources from other programs. The Department should concentrate its efforts on coordinating and organizing community services. These community services should include a strong commitment to the entire day-care system, including the reasonable maintenance of the income eligible day-care contract system, and the firm maintenance of the supportive and teen day-care contract systems. These community services should also include substance abuse programs. These programs and others should be implemented for the purpose of improving social worker performance and strengthening the effort to preserve families, however, the Department should be realistic about its capacity to reduce the time it takes to successfully intervene in these demanding cases.

Out-of-home Resources

For the nearly 75% of the families whose substance abuse treatment efforts fail, the Department must make a commitment to and have an alternative for the children. There must be placement resources available to protect children rather than maintain them in homes where substance abuse impairs their safety. Although the Department wants to maintain its families intact, given the demonstrated modest results of treatment, and, given the prevalence of substance abuse, it seems unlikely that most children are reentering safe and substance free homes.

"Family preservation" should be the goal, but, as discussed, without strong community resource support and economic opportunity, the goal will be difficult to achieve. The Department must carefully balance its zealous pursuit of "family preservation", because this effort


should not be implemented at the expense of child protection and outof-home placement security. Therefore, the Department's policieswith respect to removal and placement are very important, especiallyto social workers. Annual Department reports illustrate thesignificance and impact of removal and placement decisions.Moreover, the Department reports that there is a significantcorrelation between the number of reported children and the numberof children in placement.

"Reported children increased by 11% from 1987 to 1988, 14% from1988 to 1989, 16% from 1989 to 1990, and 13% from 1990 to 1991.Children in placement increased by 7% from 1987 to 1988, 9% from1988 to 1989, 17% from 1989 to 1990, and 13% from 1990 to 1991. ''28

"All forms of child maltreatment contribute to the placement ofchildren ... For at least the past five years, the number of childrenentering placement during the year has exceeded the number leaving.Overall, children who have entered placement are also staying for alonger duration ... For the past three years, the fastest growing agegroup in placement has been children under six years old ''29 In 1990,children under eighteen years old with cases closed remained inplacement an average of 1,111 days (31 months).

The number of "children in foster and group care placements ...increased ... rapidly (50%) between June 1987 and June 1991.Children in foster care increased 64% during this period. Theaccelerated increase in total placements during FY90 and in FY91 wasin part due to an increased length of stay in substitute care; fewerchildren being able to return home because of the elevated risk fromsubstance abuse and violence; and the diminishing availability ofsupportive services that might enable a young child to return homemore quickly. "30 As noted earlier, in FY92, the Departmentcommitted 46% of its available fiscal resources to out-of-homeplacements.

When a child must be sequestered from the source of abuse orneglect, that child's welfare depends upon the responsiveness. of theout-of-home placement system. Understanding the integralrelationship between caseload growth and the demand for placementresources is fundamental to many of the Department's difficulties.

28 Department of Social Services Annual Report on Consumer Populations, July, 1991.29 Ibid.30 Department of Social Services, FY'92 Management Performance Plan, Overview p. 2.

1992] SENATE - No. 1700 43er

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Although "family preservation" is a valuable goal, children andfamilies have a variety of needs, depending on the circumstances, someneeds which require family separation. Group placement isinstrumental to social workers' success in addressing either situation.For this reason, the Department must have a sound, reliable systemupon which they and children can faithfully depend.

CONCLUSION: Social workers do not have adequate out-of-homeplacement resources to manage cases effectively.

RECOMMENDATION: The Department's financial commitmentto out-of-home services should be maintained and used as effectivelyand efficiently as possible, including the real possibility ofrestructuring the entire out-of-home placement system.

Inter-agency Resource SupportThe Department has made a modest effort to coordinate services

for multiple needs families. The Department's Family Life Centermulti-disciplinary team approach attempts to resolve the difficulty ofservicing a multiple needs family. The Department is developingFamily Life Centers to consult with families, assess their situation andoffer "short-term intensive family intervention".31 Family Life Centerworkers from the necessary disciplines develop a service plan with theon-going social worker. Family Life Centers illustrate theDepartment's commitment to delivering responsible multidisciplinaryservices and this could develop into a valuable resource for casemanagement.

Still, many social workers identified the difficulty of obtainingservices from other agencies. Cases which require the services of manydifferent human service agencies are an increasing majority. The mostillustrative example is the relationship between the Department andthe Department of Public Health (DPH). As discussed earlier, DPHprovides substance abuse treatment resources. The Departmentdepends upon DPH for a service which is critical to its success as anagency. Yet, DPH itself has limited fiscal resources. In anotherexample, a report of abuse or neglect can often be within a familywhich also requires the services of the Department of Mental Health(DMH). In such a case, the Department has difficulty accessing

31 Department of Social Services Policy and Procedure Manual, The Family Life Center.

44 SENATE - No. 1700 [September 1

treatment services from DMH. Problems also exist with theDepartment of Youth Services (DYS) and CHINS cases as discussedearlier. DPH, DMH, DYS and other Executive Office of Health andHuman Services agencies are unable to accept responsibility forservices because of a lack of fiscal resources.

But fiscal resources is not the only problem. Implementing effectivesocial policy requires cooperation among all state agencies. It isimperative that the Executive Office of Health and Human Services(EOHHS) agencies and other state agencies upon which theDepartment depends fully understand their interdependence, actresponsibly, cooperate with one another, and use the expertise of eachagency to access any available services. This atmosphere ofcooperation must be generated from the commissioners of each stateagency.

Although the Secretary of EOHHS organizes committees andgroups to coordinate services and issues, the effort has not beensuccessful because it has been ignored. Fundamentally, families mustbe able to access any particular human services agency and thereafterreceive coordinated services from any other agency which would beresponsive to the particular family's needs. The goal is to dischargea family from state care with a greater understanding of their problemsand a feeling of confidence in being able to emotionally cope withthem. The Secretary must play a significant role in advancing interagency resource support.

CONCLUSION: Social workers tlo not have adequate inter-agencyresource support.

RECOMMENDATION: The Department should continue tomonitor the effectiveness of its Family Life Centers and the commissioners of each agency should schedule a summit to formalize therelationship among and between agencies to foster cooperation andintegration at the service delivery level.

PART II

This limited review of social workers at the Department examinedthe issues discussed in Part I. The first section focused upon whethersocial workers are professionally capable of managing child abuse andneglect cases. An evaluation of education, training, supervision and

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1992] SENATE - No. 1700 45

compensation requirements indicated that social workers are capable of managing child abuse and neglect cases. The second section focused upon whether current caseload management standards are being met. An evaluation of the current standards and the current caseloads revealed that caseload standards are generally not being met. The third section focused upon whether social workers have adequate resources to perform effectively. An evaluation of in-home and out-of-home resource availability suggests that the Department is spending an inordinate amount of time trying to adjust the need for services to meet available resources, rather than confronting the need for services and developing adequate and reliable resources to meet the need.

The pattern of growth of child abuse and neglect cases is documented. Similarly, the gap between caseload demand and resources to meet the demand is expanding (see CHART 5). At this point, in the absence of fiscal resources, the focus of concern naturally becomes: how can the Department achieve a reduction in caseload without affecting the quality of protective services? Since the standards are not being met, this part suggests areas for the Department to examine to reduce the number of abuse and neglect situations to which social workers must respond. Also, since the need to relieve the burden upon social workers through effective use of outof-home placement resources is foremost, this part also suggests one primary area for the Department to explore that may advance that goal.

CASELOAD REDUCTION

While a reduction in caseload is the goal, the Department must not mandate arbitrary case closings. There must be a direct policy to do so while maintaining the integrity of each case. The following sections recommend some possible alternatives for the Department to pursue in order to reduce caseloads without affecting the quality of protective serVIces.

Project Protect

In January 1990, the Department initiated Project Protect to "ensure greater protection to children and families where substance abuse and family violence place them at risk, and to provide support and guidance to social workers dealing with some of the most difficult


and challenging cases the Department has seen. "32 The project is apolicy directive designed to protect children and assist families in allcases where substance abuse or family violence exist. However, theinitiative has not met its expectations.

Contrary to expectations, Project Protect produced caseloadincreases and area offices experienced an expansion of responsibilityin a less flexible system for managing families (see CHART 7).

While still remaining committed to protecting children andstrengthening and encouraging family life, the Department canmodify Project Protect. Area offices need a clarification ofexpectations and responsibility when confronted with cases involvingsubstance abuse or family violence. The question which needs to beanswered is whether the mere existence of substance abuse is enoughto invoke intervention without an overt act of child abuse or neglect.

Without clarification of this issue, the professional staff will remainburdened with the prospect of dealing with a caseload which coulduncontrollably escalate. A policy directive in the area of substanceabuse must be focused toward child protection and the responsibilitiesunder the directive must be fully understood.

Definitions of Abuse and Neglect

The current definition of "abuse" is "the non-accidental commission of any act by a caretaker upon a child under age eighteen (18)which causes, or creates a substantial risk of, serious physical orserious emotional injury, or constitutes a sexual offense under the lawsof the Commonwealth. This definition is not dependent upon location(i.e., abuse can occur while the child is in an out-of-home or in-homesetting). "33

The current definition of "neglect" is "failure by a caretaker, eitherdeliberately or through negligence or inability, to take those actionsnecessary to provide a child with minimally adequate food, clothing,shelter, medical care, supervision, emotional stability and growth, orother essential care; provided, however, that such inability is not duesolely to inadequate economic resources or solely to the existence ofa handicapping condition. This definition is not dependent upon

J2 Department of Social Services Policy and Procedure Manual, Project Protect .

.13 110 CMR § 2.01

~r 1992] SENATE - No. 1700 47

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location (i.e. neglect can occur while the child is in an out-of-homeor in-home setting). "34

Broad definitions of "abuse" and "neglect" expand the scope ofresponsibility of the agency. As the number of abuse and neglectreports increases, the demands upon social workers increase as well.

A social worker's primary responsibilities are to timely screen,investigate or assess reports of child abuse and neglect in order tocreate a service plan which outlines the alternatives available for thatchild. To ease the burden upon social workers, the definitions of"abuse" and "neglect" need examination. If the agency expects toachieve results, the agency must adopt narrow definitions.Unfortunately, the fiscal alternatives available to the agency compelit to make this option a viable one.

The National Association of Public Child Welfare Administratorssuggests the following definition as a model:

Child abuse and/ or neglect is any recent act or failure toact on the part· of a parent that results in death or seriousphysical, sexual, or emotional harm, or presents an imminentrisk of serious harm to a person under age 18.

"The scope of Child Protective Services activity is limited to intrafamilial situations in which the perpetrator is identified as the parent,guardian, foster parent, or other person who is continuously orregularly in the child's home. Third party perpetrator cases are notprotective but criminal issues and should be referred to lawenforcement. "35

The Department should adopt this definition.

Intake

The Department's broad intake responsibilities consist of threetypes: voluntary intake; CHINS intake; and a § 51 A report of abuseor neglect. There are procedures for social workers to follow at intake.Although the majority ofcases handled by the Department result from§5l A reports, other types of intake contribute to the total numberof cases. Of the three types of intake, only one, §51 A reports of abuse

34 110 CMR § 2.35

3S National Association of Public Child Welfare Administrators, A Model System of Protective Servicesfor Abused and Neglected Children and Their Families (Washington, D.C.: American Public WelfareAssociation, 1988).


and neglect, should invoke an immediate service delivery responsefrom the Department. The remaining two types of intake require somemodification.

First, the Commissioner should reconsider alternatives such as thesocial workers union proposal to temporarily suspend intake of allexcept the most serious and immediate voluntary needs cases. In

. FY91, the Department managed 3,690 family requests for services,and III family requests for emergency services. While the Departmentmust maintain a commitment to the emergency requests for services,it should consider extending the time constraints upon social workersfor managing the non-emergency requests for services.

Second, although §51A reports of abuse and neglect and voluntaryintake are undoubtedly within the purview of responsibility for theDepartment, "children in need of services" or CHINS cases may notbe best managed by the Department. In FY91, the Departmentmanaged 1,171 CHINS cases. The Department should reassess itsresponsibility under the "CHINS statute". It should focus on waysto amend it. As it makes this review, Departmental policy makers mustrecognize the fundamental distinction between juveniles who abusea family or community, and children who are abused by a family orcommunity. The primary mission of the Department is to address thelater situation, and the skills necessary to do this may not be adequateto address the former.

The "CHINS statute" provides judicial options upon petition bya parent or legal guardian or police officer. The court may decline toissue the petition because i) there is no probable cause to believe thatthe child is in need of services; ii) the child's best interest would beserved by informal assistance without a trial on the merits, in whichcase the child is referred to a probation officer; or iii) issue a petitionand schedule a tria1.36

Upon making an adjudication that a child is in need of services,the court has several options: a) permit the child to remain with hisparents; b) place the child under the care of another guardian; or c)commit the child to the department of social services. 37 It is the courtsexercise of the option to commit the child to the Department whichmerits examination.

36 MGL Ch. 119 § 39E

37 MGL Ch. 119 § 39G

1992] SENATE - No. 1700 49

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Section 39G further states that "A child found to be in need ofservices shall not be committed to an institution designated oroperated for juveniles adjudicated delinquent. However, such childmay be committed to a facility which operates as a group home toprovide therapeutic care for juveniles regardless of whether juvenilesadjudicated delinquent are also provided care in such facility and may,in addition, be referred to the department of youth services forplacement in individual foster care." The statute is flexible enoughto create at least three possible options for the Department whichcould reduce its responsibility for CHINS cases referred to it by thecourt.

The first option involves making municipalities responsible forservices through youth services departments and community grouphomes (discussed later). CHINS cases are more easily referred andmanaged within a community. The Governor and the Legislature musttake an active role by appropriating money and encouragingmunicipalities to create local youth services departments and todevelop community based group homes. CHINS cases can best bemanaged at a local level in cooperation with local schools and courts.

The second option involves referring cases to DYS. TheDepartment however has difficulty making referrals because DYSoften will not accept cases because they claim to have not enough fiscalresources (an alternative not available to the Department). To addressthis issue, the Legislature should amend § 39G(c) to give the courtsthe option of committing a child to either the Department or DYS.

The state created the Department of Youth Services to "providea comprehensive and coordinated program of services to juvenileoffenders referred or committed to the department by the courts; andthrough purchase of services from private non-profit agencies andservices and facilities for the study, diagnosis, care, treatment, andrehabilitation of all juvenile offenders referred or committed to thedepartment. "38 Although this mandate is specifically aimed at juvenileoffenders, DYS should be responsible for CHINS intake as well.CHINS and juvenile offender cases are inherently different than childabuse and neglect cases. CHINS and juvenile offender cases share thecommon characteristic of the social behavior of a child affecting theway a family functions. Child abuse and neglect cases, on the other

38 109 CMR § 2.01


hand, involve the social behavior of a family and the way it affectsa child. This is a fundamental difference.

A third option is for the Commissioner to organize a summit ofstate social service agencies, as discussed herein, and develop acooperative effort among agencies to handle CHINS cases. There areviable alternatives to managing CHINS cases, but it requirescooperation and a coordinated effort.

Number of Social Workers

In the mid-eighties, the Department "pursued a strategy ofaggressive reductions in support positions to balance the creation ofdirect service positions".39 The "Weld Cellucci Fiscal RecoveryPackage", in addition to "contain[ing] a major case managementinitiative...centered upon the supervision process and utilizationreview principles", called for "a reduction of 114 social work stafffromJune 1991 to October 1992 to achieve an assumed $3.5m ~avings".4o

In addition, the Legislature required the Department to manage allcases being managed by the private agency service system (PAS). Incompliance, the Department reduced the PAS expenditure from$19.6m to approximately $10.6m and<hired 100 new social workersto assume the PAS caseload (which is over 2,000 cases from nearlyeighty private organizations).41 The Department completed thetransfer and hiring process by October 1, 1991.

Social workers connect families to services and are indispensablein this capacity. To accomplish the Department's policy objective ofproviding "family preservation" services when it is beneficial to thechild, and placement services when they are necessary, the directservice delivery component of the organization must be designed toperform effectively and efficiently. This requires adequate personnelresources.

The Department is divided into administrative support and directservice positions. The average administrative support work force forFY91 was 187 and the average work force for direct services was 2,025.Direct services positions are social worker I, social worker III, socialworker IV (supervisor), area manager, social worker technician,

39 Department of Social Services, FY'92 Management Performance Plan, Case Management, p. I.

40 Department of Social Services, FY'92 Management Performance Plan, Case Management, p. 2, criticalcomment p. 3 of 7.

41 Department of Social Services, FY'92 Management Performance Plan, Case Management, criticalcomment p. 7 of 7.

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1992] SENATE - No. 1700 51

program development specialist and nurse. In November of 1991 there were 1,712 social worker I's and social worker Ill's. There were 321 social worker IV's. In FY91, of an average 2,025 direct service work force positions, there were 250 (of 309 total for the Department) terminations or 12.3% turnover rate. Boston area offices had the highest average turnover rate of 17%. This compares with a statewide average direct service position turnover rate in FY90 of 14%, FY89 17%, and FY88 17%. Most terminations involved workers with between one and three years experience.

The number of social worker I's and Ill's should increase as soon as the fiscal resources become available. The number of social worker IV's should also increase to maintain a 1:5 supervisory ratio. A recent quarterly request for social work staff was for 309 new positions to manage the current caseload according to the current caseload standards.

These recommendations illustrate that it may be possible to streamline the agencies' responsibilities while maintaining a strong commitment to protecting children and servicing families. But certainly the incidence of abuse and neglect situations to which social workers are required to respond must be reduced to provide the Department with the best opportunity to meet their objectives.

RECOMMENDATION: The Department should: a) modify Project Protect; b) rewrite the definition of "abuse and neglect"; c) modify the Department's intake responsibility; d) add social worker positions.

OUT-OF-HOME PLACEMENTS

The out-of-home placement alternatives available to social workers have significant shortcomings. Since the first part of the report illustrated the importance of having a strong, reliable, accountable out-of-home placement system, it is useful to explore a supplementary alternative structure which may resolve some of the problems with foster care, in-home care, and the current residential care system.

First, the current foster care system is under constant criticism and review. This report does not investigate the adequacy of the foster care system as it currently exists. However, there are obvious inadequacies regarding the Department's ability to single handedly manage the overwhelming burden placed upon foster care. In FY90 and FY91, 81% of the children in placement were in foster care and


13% were in residential care. In FY92, the Department anticipates itwill spend approximately 75% of its out-of-home placement budgeton foster care and approximately 9% on residential care. Expenditurelevels in this area needs to be significantly adjusted. Second, in-homecare is often not an alternative because the Department has anunequivocal responsibility to remove a child from an unsafe environment when it exists. Third, the current residential care facilities havesignificant disadvantages. Among the most significant disadvantagesare placement in different parts of the state, increased length of stay,placement in different schools and, distancing from the families thatthe Department is trying to preserve. Two fundamental aspects of outof-home care are deficient in the current system: maintaining childrenin their own community and offering one stable placement residenceduring case management. The following section recommends onealternative toward a systematic reformation of the out-of-homeplacement system.

Community Group Homes

There is a current trend to make communities more responsible forthe care of their own residents. Child advocate groups have beenencouraging the Department to develop a new strategy which issupported by a firm network of dependable community services. Toaddress the problems and deficiencies outlined above and to givesocial workers reliable placement resources which compliment thepolicies of the Department, the Department should gradually investout-of-home placement resources into "community group homes".Most likely, this effort would reflect a gradual reduction of foster carespending in favor of greater investment in newly developedcommunity group homes. This initiative could significantly reducemany of the burdens upon social workers, including high caseloadsand case management problems. This initiative could also providefamilies with alternative support from what is currently availablewhen family situations require such alternative support.

This change represents an important adjustment to the current outof-home placement system. The current system is "a system [which]encourages the smaller community to work off on the state a burdenthat should be bourne locally. "42 The state gradually progressed into

42 J. P. Buyers and F. H. Mills, A Report on Certain o/the State Charitable Institutions, June IS, 1911,p.4.

1992] SENATE - No. 1700 53sitgetHemeanmlvegesay,latut'enicememe

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this structure. The history of social services reveals that managementbegan as a local responsibility and the general responsibility of thestate, through its agencies, was administrative and supervisory. Themovement away from this was termed "wholly progressive for goodadministration and for the children's welfare."43 Today, however, the"wholly progressive" policy for the state is to return the focus of careto local communities and to provide adequate fiscal and administrative support for such efforts.

The division of local and state responsibility for the care ofdependent children is an important debate. Now, the ideology ofexclusive state care should yield to a more progressive system. Thestate should maintain a dominant fiscal and administrative role, yetlocal communities should provide and coordinate the group homesites and resource support from which children should receive care.The current system should focus back to community group care ofabused and neglected children and provide stability for children incommunity group homes when children and families would benefitfrom this placement alternative.

The Governor and the Legislature must provide fiscal and administrative leadership and support and encourage municipalities toaccept direct responsibility for the needs of their community. To dothis, the state must encourage municipalities to identify properties forrenovation and development within their communities. Safe, secure,community group homes are needed.

In this model, municipalities become contracted service providersfor the Department. Towns not only maintain community stability,but they also save on the higher cost of educating their children indifferent education systems while the child remains in placement inthat community. This model can alleviate much of the burden uponthe foster care system and reduce the time children remain inplacement, often away from the child's community. These facilitieswould also decrease "foster care drift" and absorb the difficultproblems that children often carry with them.

To substantiate the effects and benefits of community group homes,the Department should conduct an exhaustive study of theeffectiveness of the Hingham South Shore Educational Collaborativeprogram. It is a unique program with distinct advantages over the

43 The Board of Charity, House Bill No. 1181, January 8, 1918, p. 3.


existing residential care facilities. It is a residential treatment centerand an independent living environment combined. It is short term(average length of stay is seven months). They provide counseling andtherapy for children and their families. The center is community basedand most children are from the surrounding communities. It is ownedby the Hingham Housing Authority and leased 1/8 each to the townswho participate in the program. The fourteen children who live at"Beal Street" are fourteen to seventeen years old. The Departmentpays on a per child/ per day basis.

This program can work for all age groups and can be helpful tocoordinate the efforts of social workers. This would be a significantstep toward decreasing the burden on social workers and increasingthe effectiveness of service planning aimed at reuniting families orproviding a permanent adoptive home.

Localities must be willing to absorb the responsibility of caring forits families. The importance of a community oriented support systemis self evident. Family values are most clear at the community leveland community needs can be effectively addressed at that level.Communities must take an active role to make placement servicesavailable.

RECOMMENDATION: The Department should initiate a newcomprehensive community services strategy, including an effort torestructure and localize the out-of-home placement system bygradually investing placement resources into newly developedcommunity group homes. The Governor and the Legislature mustprovide financial and administrative leadership and support andencourage municipalities to develop or renovate properties withintheir communities into group homes. This initiative should begin witha study of the Hingham South Shore Educational Collaborativeprogram.

CONCLUSION

Since 1983, there has been a significant increase in the reportedincidence of child abuse and neglect and a significant decrease in fiscalresources. Recently, the state illustrated its difficulty managing thisinequity. This report focused on the ability of social workers to deliverprofessionally acceptable service~ within the child protection system.

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This report concludes that social workers are professionally capable of managing child abuse and neglect cases. However, caseload standards are not being met and this significantly inhibits their ability to manage cases well. Further, this report concludes that in-home "family preservation" resources, out-of-home placement resources, and resource support from other human services agencies are inadequate.

As a result of these conclusions, this report offers two additional recommendations. First, the report recommends methods to retard caseload growth. Second, the report recommends the restructuring and localization of the entire out-of-home placement system.

The Department of Social Services needs to adopt a clear strategy for future management of child abuse and neglect situations: a strategy which effectively uses the capabilities of its social workers; a strategy which answers the challenge of their mandate; a strategy which meets the needs and expectations of each victim of child abuse and neglect in the state. This is a difficult responsibility to bear, but it is a responsibility that the Department must be expected to manage.


AUDITEE'S RESPONSE

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I 'fhe Commonwealth 01 Massachusetts

1Dr Executive Office of Health and Human Services ~ Department of Social Services

WTLUAM F'. WELD Governor

+ OA\1D P. F'ORSBERC

Secretary

+ CERALD W. ROBINSON

CommIssioner

24 Farnsworth Street, Boston, Massachusetts 02210 Tel (617) 727-0900 + Fa:, 1617) 261-7435

Senator Thomas C. Norton, Chairman Senate Committee on Post Audit and Oversight Room 312 State House Boston, MA 02133

Dear Senator Norton:

Thank you for the opportunity to review and comment on the limited performance evaluation of the Department of Social Services drafted by the Massachusetts Senate Post Audit and Oversight Bureau. It presents a number of interesting insights and conclusions.

In general the report is consistent with several of the Department's recent program initiatives and Family Preservation ideology. Many of your recommendations are consistent with our own findings, and our current, budget, management and planning priorities. As part of its budget, management, and systems planning, DSS has been reviewing and rethinking the manner in which it serves families and children. DSS is involved in a philosophical and programmatic shift to family-based service delivery. DSS is attempting to develop statewide family preservation projects, and has embraced a basic principle that every child is entitled to grow up in a permanent family.

The context for DSS's program and policy discussions concerning family preservation is an ideological framework that includes:

1. A commitment to support families; 2. A belief that community investments, both human and financial

are necessary to address the needs of vulnerable families before cnses emerge;

3. A belief that a service system must be based on family strengths, and not deficits and dysfunction;

4. A -commitment to the philosophical and financial support of a system of family-based services, rather than a collection of program models.


Due to the ever increasing demand for child welfare services, DSSundertook an examination of our service delivery system. What weobserved was that a shift had occurred in the distribution of resourcesfrom those that help support intact families to resources that fundout of home placements. It became apparent that services to preservefamilies need to be strengthened. In responding to the dauntingchallenges which face the Department, we are emphasizing a familypreservation ideology and family-based service approach to servingand keeping troubled families intact. The Department has proposedto adopt and put into practice new standards of service delivery andmanagement control to ensure that as many families as possiblebenefit as much as possible, from the Family preservation approach.

The biggest management challenge facing DSS and its providercommunity for the foreseeable future is diversion of financial andother resources away from a historically heavy investment in out-ofhome placements to an investment in family preservation andreunification services.

Currently, there is a substantial range and variety of areacommunity based services being provided to DSS clients. For thefuture, integration among service providers must be emphasized andbecome the "norm" for DSS-funded programs. The development ofintegrated, community service systems is fundamental to meeting thegoals and objectives of the Department.

As the Department moves forward in the management of a complexsocial service system, issues related to staff retention, recruitment,training utilization, development and deployment are intrinsic to thesuccessful implementation of the Department's mission. Just as theempowerment and self-fulfillment of DSS families is a value of theDepartment, so too is the enhancement of skills and knowledgeleading to greater empowerment and effectiveness of DSS staffmembers. The type of professional expertise and commitment which~SS needs to function will require that human resource planning bea priority throughout the DSS system.

Faced with a changing staff configuration, a renewed emphasis onfamily preservation, and tightening fiscal constraints, DSS mustenhance staff training and development. Increasingly, those who areinvolved in supporting children and preserving families realize thata variety of interventions are necessary over time. Training staff,whether in programs operated by the Department or in private sectorcommunity programs funded by the Department, is critical.

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The Commonwealth has recognized the outstanding problems associated with today's system of child care and the need for systemic reform. When properly funded and executed, family preservation offers lawmakers an opportunity to begin a process of reform in children's welfare and family services. Although only a part of the welfare network, these services demonstrate that holistic approaches respond effectively and efficiently to the multifaceted needs of families; while at the same time family preservation services guarantee effective and efficient use of resources.

We see a logical connection between family preservation and its role in a larger preventive service system model. The philosophy of family preservation is at the intersection of several public policy initiatives, including service integration, coordinated service delivery and nonintrusive government programs. It is also representative of a fundamental prevention model of service delivery.

To the extent that future costs will be inflated purely by shortages (especially for foster care arrangements) family preservation could have an important moderating effect simply by reducing the size of the demand. Over the long term, the savings to taxpayers of the real (albeit hard to estimate) costs could be very large indeed.

The longer term fiscal implication of family preservation may have an even more significant analogue on the programmatic side. The child welfare benefits of family preservation are most often envisioned in terms of the children whose removal is prevented.

But family preservation may also enable an improvement in the care and welfare of children in placement. By virtue of its ability to reduce the number and incidence of removals, a strong family preservation capacity would lessen the pressure on a state's available out-of-home resources. This, in turn, would increase our potential to sustain a true continuum of care, of making prompter and more appropriate placements, of funding placement settings closer to home, and of assuring better supervision and treatment of those children in its care. In short, a commitment to family preservation contains within it at least some potential to alleviate the crises that currently affects child welfare's response to the needs of children in placement.

At a minimum, a commitment to family preservation for at-risk families would yield a system less reliant on placement, less reactive and more affirmatively committed to families as the context for securing the safety and welfare of vulnerable children.


Given the challenges it currently faces, DSS has designed andalready begun implementation of four important initiatives toestablish its own statewide family preservation program and improveits permanency planning services and case management.

Implementation of Family Preservation Service Networks:Development of flexible networks of service providers toensure access to a broad range of progressively more intenseservices to help families avoid placement.

Improvement of Permanency Planning Services:Streamlining of DSS 's existing permanency planning services:to expedite adoptions and reduce the time that children whocannot be reunited with their families have to spend in custodyof the Commonwealth.

Improvement of Case Management and the Integration ofServices: Implementation of a new utilization managementsystem for the Department to strengthen case management andcontrol, as well as pursuit of new cooperative arrangementswith other agencies to serve all needed services for DSS clients.

Coordination and Enhancement of Human ResourceDevelopment Programs: Effective training of DSS staffmembers and contract provides in the philosophy and practiceof Family Preservation to ensure successful implementation ofDSS's new service delivery approach and high quality for allDSS's service.

Change of this magnitude is significant, however the need toimplement the recommendations which you have suggested is great.We have attempted to initiate systematic strategic change rather than"careless redistribution of limited fiscal resources from one programto another".

We look forward to a coordinated service system that serves theCommonwealth's children and families.

Thank you for your Committee's time and interest in the importantinitiatives of the Department of Social Services.

Sincerely, ,I) 1/ .v~cJJuJ~

Gerald W. Robinson. 'Commissioner.

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1992] SENATE - No. 1700

OTHER REPORTS IN THE 1991-1992 LEGISLATIVE YEARS BY THE SENATE

POST AUDIT AND OVERSIGHT BUREAU

61

February 1991 EARLY RETIREMENT: DESIGNING AND IMPLEMENTING AN INCENTIVE PROGRAM IN MASSACHUSETTS (S.1361)

April 1991 AN ANALYSIS OF THE MASSACHUSETTS EXECUTIVE BRANCH WORKFORCE (S. 1490)

June 1991 CONTROLLING STATE EMPLOYEE HEALTH CARE COSTS (S. 1610)

October 1991 LOTTERY REVENUE GROWTH: PROSPECTS FOR THE FUTURE (S. 1720)

April 1992 THE DECISION OF THE MASSACHUSETTS STATE LOTTERY TO OFFER "LOTTERY-BYPHONE" (S. 1480)

May 1992 PAYING FOR HOSPITAL CARE IN MASSACHUSETTS: THE COMPETITION EXPERIMENT (S. 1500)

June 1992 MASSACHUSETTS PUBLIC LIBRARIES IN CRISIS: THE BURDEN OF NON-RESIDENT LENDING AND BORROWING (S. 1635)

This Document Haa Been Printed On lOOCJt, Recycled Paper.

Documents

SENATE. • • • • • . No. 1700 · 1992] SENATE - No. 1700 7 I [1 5 • The Departmentshould explore the causes ofthe apparent gender and minority based salary disparity which