Emotional Challenges in Child Welfare Practice
(Originally published June 2017)
The public imagination shrinks from child welfare practice. Compare the endless fascination with law enforcement in novels, movies and television series with the lack of interest in or disapproval of child welfare caseworkers. Stories of good cops, bad cops, vigilante cops, etc., fill the airwaves, and these stories focus not only on police work, but also on the personal lives of police and other law enforcement agents. In contrast, when child welfare caseworkers appear in movies, television shows or novels, they are likely to be portrayed as officious bureaucrats, moralistic scolds, or even (as in the most recent year of Homeland) as an agent of malign forces.
Child welfare practitioners are likely to encounter a wide range of reactions in the communities where they work, ranging from admiration and respect of community professionals to feint repugnance from persons with little or no knowledge of child welfare. Similar attitudes are often found in MSW programs, especially regarding child protection about which most social work faculty are poorly informed. In addition, there is a lack of insightful first hand accounts of what it is to work in child welfare. I know of nothing that approaches the quality of Elizabeth's Ford's recent book, Sometimes Amazing Things Happens, an engrossing account of a psychiatrist working with a mentally ill criminal justice population. The lack of knowledge regarding child protection in most academic settings, combined with the public's lack of interest in the human dimension of child welfare work, has led to an imaginative void in which the perspectives of child welfare are rarely considered in policy discussions or reform initiatives. Newly hired child welfare caseworkers may have little idea of what they are likely to encounter in their contacts with families unless they have done a practicum in a child welfare office.
Newly hired child welfare caseworkers are likely to be hired into some of the most emotionally difficult jobs in a public agency, not the easiest jobs which have usually been taken by experienced staff. These casework positions (for example, CPS caseworker) put new staff into daily contact with a troubled population of families in which substance abuse, mental health problems, interpersonal violence and poverty (often dire poverty) are common. Newly hired staff are often shocked by the conditions in which families live and the mistreatment of children by some of these parents. They may ask themselves a question which most are prudent enough not to articulate to their supervisor or training staff: “How can families live like this?” They may also struggle to understand what child safety means in these circumstances, a question that child welfare training programs need to address repeatedly with the use of case scenarios.
A common emotional response of child welfare staff to parents and children with open child welfare cases is a moralistic division of family members into perpetrators and victims, a perspective which is understandable when children have been severely physically abused, sexually abused and/or emotionally abused, or when one parent (usually the mother) is severely harmed by her husband or boyfriend. However, this perspective does not work as well in many neglect cases, or when a mother who is herself a DV victim becomes an abusive parent. Lots of moralistic judgments in child welfare do not concern child maltreatment directly, but follow strong emotional reactions to filthy and smelly homes, the resistance of demoralized parents to offers of help, encounters with drug/alcohol addiction, the unwillingness of DV victims to separate from perpetrators or other conditions in which moralistic reactions to messy human problems get in the way of effective interventions.
Some caseworkers and supervisors develop highly empathetic and impassioned responses to one or more groups of children and parents, for example, to victims of child sexual abuse, DV victims, Native American families or DD parents. Child welfare staff may become strong, knowledge-able advocates for specific groups, both within the child welfare agency and in the community. Their advocacy often raises the bar for child welfare policy and practice in serving groups whose needs have been poorly understood or ignored. However, empathetic responses can go awry. Practitioners can become emotionally enmeshed with abusive or neglectful parents, causing them to minimize risks to child safety and to make poor decisions based on the illusion that persons one empathize with have no faults while persons viewed as villains have no virtues, i.e., the halo effect. Empathetic reactions that lead to poor decision making become common when strong emotional identification with persons or groups are combined with political or social ideologies of various sorts. Strong emotions combined with inflexible beliefs is a formula for bad decision making carried out in a self righteous way.
Most caseworkers will eventually find a middle way in which both moralistic reactions and empathetic responses are moderated by the expectations of their professional role. Child welfare staff are expected to be civil and respectful of parents. They must be concerned about the safety and welfare of children, helpful to the extent permitted by available time and resources, ethically sensitive to potential abuses of power and conflicts of interest, collaborative with community professionals and foster parents, and emotionally balanced and thoughtful in response to difficult challenges. Most caseworkers and supervisors attempt to maintain clear emotional boundaries between themselves and parents at all times, sometimes to an extreme degree. I once heard a veteran caseworkers refer to “the defense mechanisms our clients use,” i.e., mostly denial and projection, which are common responses to unwelcome information in all social groups. Caseworkers who violate boundaries between themselves and parents for whatever reason will likely receive strong disapproval from their peers. Even caseworkers who become licensed as foster parents by private agencies and take abused and neglected foster children into their home may be viewed critically by their peers. Role governed boundaries between parents, children and caseworkers are viewed as the foundation of moral probity in public child welfare systems. However, strict boundaries between caseworkers and parents may result in an emotional distancing and some degree of desensitization to suffering on the part of child welfare staff.
The Stress of Decision Making
Imagine the challenge facing many caseworkers in their first few months of child welfare: during or immediately following a basic training program, they are assigned cases with complexities for which they are not prepared. Training programs will often have provided a large amount of superficial information about a wide range of subjects with an emphasis on computer procedures needed to document case activities, authorize services and complete assessment tools. Newly hired staff are likely to to be aware that they know little or nothing about child protection or other aspects of child welfare, a self awareness that creates a near constant anxiety. The practice models used by child welfare agencies may be highly conceptual and difficult to learn or depend on rudimentary social work skills that require repeated practice to master. If caseworkers are fortunate, they will have an experienced, knowledgeable supervisor who gives them daily attention. If they lack a supportive and accessible supervisor, newly hired caseworkers must look for a mentor, e.g., a peer or coach who takes an ongoing interest in their development. If a new caseworker has poor supervision and no mentor, they are in deep trouble. They may be frightened (with good reason) of making a critical mistake that endangers a child's life or of being humiliated in court or in a case staffing with peers and other community professionals.
Inexperienced caseworkers may also be alarmed by the degree of conflict they encounter within the agency, for example between units over transfer policies, or with agency managers over workload and compliance issues. New staff will discover that a wide range of community professionals, including attorneys and therapists, have strong opinions about their assessments and case plans, and that differences of opinion among professionals and with foster parents regarding child protection and permanency issues are endemic in child welfare settings. Maintaining emotional control in the midst of these conflicts is of the utmost importance to a caseworker's reputation and career prospects.
High degrees of stress with low levels of emotional support and little control over one's work will often lead to a wide range of emotional and physical ailments, including (but not limited to) sleep disturbances, headaches, stomach ailments and chronic fatigue. In these circumstances, some caseworkers will begin to look for the exit door during their first year of employment. Caseworkers determined to persevere while they learn the job will quickly discover the importance of a cohesive work unit in which they feel accepted and valued, a small group that affords mutual protection and allows an honest sharing of feelings and insecurities among peers. Hopefully, there will be one or more experienced, competent caseworkers in the unit who demonstrate to new staff that it's possible to survive and thrive in child welfare.
Until caseworkers have the knowledge and skill to be reasonably confident regarding their decision making abilities, child welfare practice will be an aversive experience. Assessment skills take time to learn; they can not be reduced to procedures or to completing standardized assessment tools. Child welfare trainers sometimes hear the demand from caseworkers in basic training programs that they should “just tell us what to do.” These caseworkers are unlikely to appreciate the following advice:
Study your profession; continually deepen your knowledge and understanding of subjects relevant to child welfare practice.
Learn to think critically about evidence; demand clarity of oneself and others in argument and discussion.
Use intuition but do not trust it uncritically, especially during the first few years of casework practice.
Be willing to admit error and change your mind in response to new information; beware of confirmation bias.
Reflect on your approach to decision making and your emotional reactions to the work in discussions with peers and your supervisor.
Carefully observe experienced caseworkers and supervisors who consistently do outstanding work.
Come to work prepared for conflict; don't attack the character or motives of those with whom you disagree.
Most inexperienced staff who follow these guidelines will eventually welcome and enjoy the decision making challenges they once found painful. The exercise of complex skills which are difficult to acquire can be a thrilling experience. Unfortunately, this seems to be a well kept secret in child welfare agencies around the world.
Burnout, Secondary Trauma and Compassion Fatigue
Experienced caseworkers and supervisors have usually adapted to the decision making demands of their jobs, either through increased knowledge and improved assessment skills or through the use of simplified rules (see Michael Lipsky's Street-Level Bureaucracy, 1983). However, as the stress of decision making is reduced, other facets of the work may exact a greater emotional toll. In the next Sounding Board I will discuss the frustrations of working in a large bureaucracy, frustrations that are often more deeply felt by experienced staff than inexperienced staff. No one ever gets used to threats of harm or actual attempts to do harm from parents or, occasionally, from adolescents in foster care or residential care. Child welfare is a dangerous occupation. Experienced caseworkers are likely to remember “close calls” in threatening circumstances when they could have been seriously harmed or killed.
Possibly the greatest emotional damage to child welfare staff is the result of conflicts with colleagues within the agency or in the community that have taken an ugly turn. I once witnessed a spectacular burnout of a highly respected caseworker after this person was denounced by a judge in open court for allegedly misrepresenting case information. The caseworker never recovered from this humiliating experience. Experienced caseworkers may have learned to cope with differences of opinion that are common in child welfare, but be devastated by personal attacks on their character or competence.
One of the best recent personal accounts of burnout and secondary trauma in human services jobs is contained in Elizabeth Ford's, Sometimes Amazing Things Happen. Ford's memoir is about her work with mentally ill prisoners in New York City's Bellevue Hospital. Many of Ford's patients were psychotic and emotionally dysregulated to an extreme degree. Ford describes frequent conflicts with corrections officers and nursing staff over her reluctance to use physical force or medications, i.e., “chemical straitjackets” with patients, and conflicts with her superiors over discharge plans. After years of experience and while she was pregnant, she found herself becoming increasingly upset by the level of violence in the psychiatric ward and was consistently unable to calm herself. She began to have disturbing dreams of dismemberment and kidnapping, dreams that mirrored the fears of her patients. Instead of empathy, she became emotionally hardened to the point where she didn't care what happened to patients. She had the insight that her ennui with the work was a mask for fear. She retreated from colleagues and became socially isolated at work. These are common signs of depression (lack of concern for patients, social isolation) and trauma (stress reactivity, emotional dysregulation). Ford ended up leaving the hospital for an extended period, but returned after she rediscovered her interest in work for which she had an extraordinary gift.
In Ford's case and in others I've witnessed in child welfare agencies, experienced staff are most vulnerable to burnout and secondary trauma when they feel ineffective and unappreciated. In child welfare settings, the best protection against burnout and vulnerability to emotional meltdowns is the acquisition of influence in the agency and the community, influence that allows practitioners to actually help children and families. However, when burnout occurs, it may not be terminal. With some experienced staff, sometimes amazing things happen, and, after a break, they find a second life in a profession they were born to do.
Ford, Elizabeth, Sometimes Amazing Things Happen: Heartbreak and Hope on the Bellevue Hospital Psychiatric Prison Ward, Regan Arts, 2017.
Lipsky, Michael, Michael, Street-Level Bureaucracy: The Dilemmas of the Individual in Public Service, Russel Sage Foundation, 1983.