The Real Story of Abused and Neglected Children and the People that Serve Them In Greene County, Missouri

Transcription

1 The Real Story of Abused and Neglected Children and the People that Serve Them In Greene County, Missouri The Story Line Thousands of Greene County children experience the trauma of abuse and neglect. The staff of the Greene County Children s Division (GCCD) work tirelessly to serve and protect children under conditions that only diminish their ability to do so. The Characters: The Children and Families Greene County s at-risk children are unique, valuable and deserving of quality services. They and their families represent all socio-economic levels, sexes, races, religions and cultures. The Characters: The Helpers (GCCD) According to Missouri statutes, the Children s Division (CD) is responsible for receiving and investigating all reports of child abuse and/or neglect. In addition, CD is mandated to provide services to these children, up to and including necessary placement in another home for their protection. However, the Division recognizes that children s families are irreplaceable, so the staff works to strengthen and empower families. Acting in the best interest of the children is paramount. GCCD employees perform these tasks under the seven principles that guide the Missouri Children s Division: Prevention, Protection, Preservation, Partnership, Practice, Permanency, and Professionalism. This storyline focuses on the tenets of partnership and professionalism in order to most effectively and efficiently protect the children of Greene County. Professionalism Staff are valued, respected and supported throughout their career and in turn provide excellent service that values, respects and supports families. PARTNERSHIP - Families, communities and government share the responsibility to create safe, nurturing environments for families to raise their children. 1

2 The Reality of the Story Despite the best efforts of GCCD staff, the best interest and safety of children may be compromised by the working conditions faced by the staff. For example, between FY*2009 and FY2013, the average turnover rate was 29% for all Greene County Children s Division (GCCD) staff. To put it another way, almost one in three direct services employees left the agency during that time period. In FY2013, the turnover rate in the investigations program was 46% - or almost one in every two investigator left the agency in a one year s timeframe. Because of vacancies, the GCCD is operating with only 66% of its positions filled. In order to successfully protect children, best practices recommend that investigators receive on average 12 to 15 new reports of abuse and neglect each month, while case managers are assigned approximately 15 children depending upon their level of need, and prevention services workers approximately 20 families at a time. In November 2014, one worker, who had just celebrated her one year anniversary with GCCD and had exited probationary status, received 34 new hotline reports. Investigators are routinely assigned 25 or more each month. Most foster care case managers and prevention workers also exceed the best practice standards. Under these conditions, it is challenging for GCCD to ensure the safety of abused and/or neglected children, let alone intercede on behalf of those who are at-risk for maltreatment. In FY2013, Greene County investigators received 4,096 reports of child abuse and neglect involving 5,905 children. The rate at which reports were substantiated (i.e., it is more likely than not that maltreatment occurred) in FY2013 was 9.59 per 1,000 children, well above the state rate of 4.35, which indicates the reported incidents involving children rose to the level requiring more than minimal intervention. In FY , there was an average of 850 to 890 children in foster care each month, an entry rate of 6.29 per 1,000 children, compared to a rate of 4.51 statewide. What are possible conclusions to be drawn from these facts? It is more difficult to sufficiently protect children from abuse and neglect given the turnover rate and subsequent vacancies. An unstable workforce also makes it more difficult to provide permanency for children, e.g., through reunification or adoption, when workers change and must learn anew about children and their circumstances before making life-changing decisions. Why This Story is important to Greene County Studies have shown children who have been raised in homes with positive and nurturing caregivers enjoy a better chance of becoming well-adjusted adults (Bavolek & Rogers, 2012). When a child s development is disrupted by abuse and neglect, the child is more likely to experience obstacles *FY is the fiscal year for the Children s Division, which runs from July 1 to June 30 each year. 2

3 such as cognitive delays, unhealthy attachments, and academic underachievement (Hagele, 2005; Putnam, 2006; Stirling & Amaya-Jackson, 2008). While childhood developmental disruptions are critical to address, combatting the long term consequences of child abuse and neglect is equally important. As adults, these children are more likely to experience mental health issues, substance abuse problems, criminal activity, and repeat the cycle of abuse (Doyle, 2008; Kaplow & Spatz-Widom, 2007; Spatz-Widom & Wilson, 2009; Wu, Schairer, Dellor, & Grella, 2010). These effects of abuse and neglect are easily identifiable in literature; however, quantifying the societal impact of abuse and neglect is challenging. A recent study suggested the economic cost of child abuse and neglect is over 80 billion dollars per year (Gelles & Perlman, 2012). One factor contributing to this expense is the cost associated with recruiting, training, and retaining a competent child welfare workforce. Research findings suggest the average cost involved when one caseworker leaves and is replaced by a new worker ranges from approximately $12,000 to $16,000 (Cowperthwaite, 2006; Dorch, McCarthy, & Denofrio, 2008). The cost to replace a caseworker is problematic. Nationwide, child welfare agencies struggle to recruit and retain qualified child welfare workers (United States General Accounting Office [GAO], 2003). The average annual percentage of worker turnover nationwide ranges from 12.6 to 22.1 percent. To complicate the situation further, it takes approximately 7 to 13 weeks to fill a position (American Public Human Services Association [APHSA], 2005). The large turnover rates and on-going job vacancies have prevented child welfare agencies from adhering to recommended caseload standards, participating in research-based initiatives, and maintaining an environment that places value on delivering quality services to children and their families (Child Welfare League of America [CWLA], 2002). The GCCD Story In May 2014, staff members were invited to participate in an online survey designed to ascertain the underlying causes of turnover in Greene County. Eighty percent of frontline, direct services staff and 86% of administrative staff participated in the survey, or a total of 88 employees. (Further demographic information about the staff is available in the appendices.) Staff members answered questions designed to measure factors that significantly affect workforce stability: job satisfaction, intent to leave the agency and burnout. Respectively, the instruments were: Job Satisfaction Survey (JSS) Turnover Intention Questionnaire (TIQ) Professional Quality of Life Questionnaire 5 (ProQOL5) 3

4 More information about these instruments can be found in the appendices. At the end of the questionnaire, employees had the opportunity to answer the question, Is there anything else you would like to tell us about your employment at Greene County Children s Division? Some of their responses to this question are highlighted throughout the report. The results of the survey reveal a workforce that recognizes the importance of and values the work they do. Additionally, the results shows a workforce that experiences conditions that significantly diminish its ability to protect children effectively and efficiently. Job Satisfaction: On the nine aspects of the JSS, staff members tended to be near or below the national average. The higher the score, the greater the satisfaction on a particular aspect: Job Satisfaction Survey Comparison National Average GCCD Average Significantly, one of the highest scores among GCCD staff was the nature of the work itself, indicating the satisfaction workers gain from their jobs. Participating employees also indicated higher satisfaction with the supervision they receive, their co-workers, their fringe benefits and the nature of communication within the agency. Staff members reserved their lowest ratings for the salaries they receive and the conditions under which they work, including the location of their workspace. Contingency rewards (i.e., nonmonetary recognition) and opportunities for promotion also were among the lowest rated facets of job satisfaction. 4

5 Ratings by direct services and administrative staff were within one point or less of each other with a few exceptions. Administrative scores were higher on four subscales: opportunities for promotion, contingency rewards, the nature of the work and internal communications. The satisfaction workers feel with the nature of the work they do clearly is stated by one employee. I love the job I do; I just would like to have more time to do the job. I feel as it is constant rush, rush, rush, and often having to recheck my work to make sure that I haven t made an error or mistake that could cause harm to a child. Direct services worker noted that despite the poor pay, the sizes of caseloads, the amount of required paperwork and the constant turnover, the work is rewarding. I love what I do; I love working with children and helping families. Workers also shared their concern about their office space, which is in the State Office Building on Park Central Square in Springfield and where different programs are located on several different floors. One worker voiced concern shared by others: I do not feel safe working after hours and on weekends in our current location. On call staff responsible for investigating hotline reports must be available 24 hours per day 7 days per week requiring them to be in the downtown offices at all hours of the day and night. Additionally, staff work after hours and on weekends because of the constant turnover and staff vacancies. According to one employee, We work many hours over and receive compensatory time, which is difficult to take with the overwhelming amount of work and caseloads. 5

6 Turnover Intention: Job satisfaction and turnover intention are inextricably linked together because the less satisfied employees are, the more likely they will plan to leave the job. Participants answered three questions to measure their intent to leave the agency. The scale for the three item Turnover Intention Questionnaire (TIQ) runs from one to seven with higher scores indicating greater agreement with the question. The responses of the GCCD staff are displayed in the table below. GCCD Average Scores on the TIQ Survey Question In the last year, I have thought seriously about leaving this job. Direct Service Participants Administrative Participants (N=66) (N=18) I often think about leaving this job I will probably look for a new job in the next year Overall Score Staff responded to two additional questions that more specifically described their intent to leave their current positions, i.e., leaving the agency entirely vs. accepting another job within CD and leaving the field of child welfare services altogether. The scale for these two questions also ran from one to seven, with higher scores indicating greater agreement with the statement. According to the table below, direct services workers are more likely than administrative staff to leave the agency and the field. Where GCCD Staff Might Look for Another Job I will probably look for a new job outside of this institution in the next year. I will probably look for a new job outside of this field in the next year. Direct Service Participants Average Score Administrative Participants Average Score (N=66) (N=18)

7 Why is this the story of committed GCCD child welfare workers? The comments of one worker seem to represent similar feelings of other employees. The conflict between satisfaction with nature of the work and the reality of the job is evident: The number of hotline reports received vs. the lack of workers, makes this job impossible to keep up with, unless you are willing to work 10 to 20 hours of overtime EVERY week. That overtime does not include working late at home visits or working on call. This is the amount of time I would have to work overtime, just to get the paperwork done. I love this job, but with the turnover being so high, lack of knowledgeable [i.e., experienced] workers and overall case load sizes, I will be looking for new employment or transfer opportunities within this year. Burnout/Professional Quality of Life: A key factor influencing job satisfaction and intent to leave the agency is the quality of professional life experienced by employees. The ProQOL5, measures three aspects of the quality of an employee s professional life: compassion satisfaction, burnout and secondary traumatic stress. Workers with high levels of compassion satisfaction typically derive fulfillment from the work they do because they believe they make a difference and want to continue to do their jobs (Stamm, 2010, p. 22). Burnout is characterized by feelings of exhaustion, frustration, anger, hopelessness and powerlessness all feelings that negatively affect work performance. Secondary traumatic stress results when an employee observes and experiences extremely or traumatically stressful events (Stamm, 2010, p. 10), such as those encountered by child welfare workers. The effects of secondary traumatic stress also negatively impact an employee s work performance (Stamm, p. 13). Ideally a workforce would experience high levels of compassion satisfaction and low levels of burnout and secondary traumatic stress. On all three scales, the average scores of employees were only slightly higher than the national average. As indicated in the table below, 99% of the staff that completed the survey rated themselves average or high on compassion satisfaction. No employees rated him/herself high in burnout and only one scored her/himself high in risk for secondary traumatic stress. The high scores in compassion satisfaction indicate that GCCD staff derive fulfillment from the work they do. At the same time, the employees do not consider themselves at high risk for burnout or for experiencing the effects of secondary traumatic stress. 7

8 Professional Quality of Life among GCCD Staff Presence of Compassion Satisfaction Frequency/Percent Risk for Burnout Burnout Frequency/Percent Risk for Secondary Traumatic Secondary Traumatic Stress Frequency/Percent Low 1 (1.2%) 19 (22.6%) 32 (38.1%) Average 68 (81%) 65 (77.4%) 51 (60.7%) High 15 (17.9%) 0 (0%) 1 (1.2%) Total 84 (100%) 84 (100%) 84 (100%) All three scales completed by GCCD staff reveal they value and draw gratification from the work they do. Yet, an unstable workforce remains. If it is not the nature of the job, which often is stressful and dangerous, that explains turnover and its deleterious effects on children, what does? And what can be done to ameliorate or eliminate those causes? 8

9 The Emerging Story Staff members understand the importance of the work they do I love my job. I know it is not perfect, but I get to go home at the end of the day knowing I am a part of a team of people with an extremely honorable duty. We keep kids safe for a job. You can t beat that. Despite the satisfying but difficult nature of the job, there are conditions that diminish the stability and longevity of the workforce. One worker aptly stated that both qualities are critical to the job being well done (Anonymous, 2014). From the story of GCCD working conditions, which both positively and negatively impact employees ability to protect children, several conclusions emerge as prerequisites to the effective and efficient protection of children. Staff value and gain satisfaction from serving children and families. Under the right conditions, believe they can make a difference on behalf of abused, neglected and vulnerable children. Turnover of staff cannot be attributed to the work itself. While the difficult nature of the work will not change, the conditions in which it is conducted can and should. Staff feel supported. Staff overall enjoy the support of supervisors and co-workers, which enhances their ability to effectively do their jobs and increases longevity in the workplace. Staff need more than pay to be satisfied with and be effective in their jobs. They need to feel appreciated for the work they do and to be rewarded in ways that recognize the value of what they do, particularly given the stress inherent when they must keep vulnerable children safe. 9

10 The Governor, State Legislature, and Department of Social Services Children s Division recommended, approved, and are implementing changes that enhance staff effectiveness and efficiency: Career Ladder: Staff now has the opportunity to assume increased responsibility and pay without having to become supervisors. Previously, the only form of promotion was from case manager to supervisor, and not every worker wants and is suited for such positions. Mobile Technology: Frontline staff will soon have ipads they can use to complete forms and notes while in the field, which eliminates the need to transcribe notes when the employees return to the office. ipads can also be used to locate resources for families, connect them to services, and be used as a teaching tool. Working from home: Recently staff has been able work up to one day from home, which increases effectiveness and efficiency by providing uninterrupted time to complete required paperwork and by allowing employees to make more contacts and visits in a day without having to return downtown to the office building. Decentralized positions: Positions historically based in the Jefferson City offices are now more available to all staff. These positions can now be based in any local county office. This allows more staff the opportunity for career advancement at the central office level while increasing diversification in those positions. Local Recruitment and Retention Project: In 2014, The GCCD and the Missouri State University School of Social Work received a federal grant to recruit, develop and retain employees in the local office. The program, Preparation and Retention for Excellence and Professionalism provides stipends for up to 10 undergraduate social work students each year through The first students will become GCCD case managers in May Despite these improvements, much work remains to provide working conditions that promote rather than impede GCCD employees abilities to effectively do their jobs. Staff need: To feel safe and unified in their working environment. Caseload sizes that permit them the time required to protect traumatized children. To focus on serving children and families and not on policies that unnecessarily burden them with paperwork and deadlines. To be well-trained, prepared and experienced all the qualities children deserve. 10

11 In addition, the story is a costly one to children, families and the public: The unstable workforce results in less efficient and more costly delivery of services to atrisk children and their families. Constantly replacing and training new employees is expensive. Estimates of hiring and training new employees can reach one-third of a worker s annual salary. In 2014, 28 frontline staff left Greene County Children s Division and two more transferred to other counties. Therefore, the cost to taxpayers for replacing these personnel reaches upward of $300,000. As high turnover rates remain constant from year to year, taxpayers could see costs rise to millions of dollars. Improved working conditions would significantly reduce the turnover and the cost to people of Missouri. Costly consequences occur when children spend unnecessary additional time in foster care due to an unstable workforce. With each new worker assigned to a child come delays in achieving permanency for children. When turnover occurs, new workers must become acquainted with children and their circumstances, which delays permanency for them. For example, if a child in a residential treatment facility remains in placement one extra month because of turnover, the cost to taxpayers is $2,600 to $10,000 per month depending upon the level of care the child requires. August 31, 2014 there were 166 Greene County children and youth in various residential treatment facilities. If 10 children remain in care one month longer because of staff turnover, the cost could rise to $100,000 per month. While the financial expenses of turnover and delayed permanency are significant, the emotional and developmental costs to the children themselves are even more meaningful. With each additional worker assigned to a child, the chance of achieving permanency in a timely manner declines exponentially. Instability in placements increases the possibility of cognitive and social delays as well as long term mental health issues and substance abuse problems; in addition, such instability increases the likelihood of adult criminal activity and homelessness. Stable placements are essential for children to develop into productive, law-abiding citizens. A stable workforce is not a luxury, but a necessity to most effectively protect these vulnerable children. 11

12 The Moral of the Story The Supporting Children in Child Welfare (SCCW), a sub-committee of the Child Abuse and Neglect (CAN) Collaborative, sponsored by the Community Partnership of the Ozarks has reached the following conclusions: Staff stability... improves child safety and well-being outcomes. enhances the cost effectiveness of child protection. Is enhanced through: reasonable caseloads adequate numbers of staff safe and accessible office space and resources salaries commensurate with the nature of the job In addition, the SCCW asserts: Greene County Children s Division staff is committed to child safety. the value staff places on their work and their low- to average-range risk for burnout cannot explain turnover rates that reach 29% overall and 46% in the investigations unit. current working conditions reduce the staff s ability to ensure child safety. How Should the Story End? The end of the story will be written by the people of Greene County and the State of Missouri and their elected representatives. The citizens of Greene County have demonstrated their commitment to the children and youth in their communities through efforts such as the Every Child Promise work which evolved from the News -Leader s reporting on children s issues. The SCCW hopes that a similar level of dedication and energy will be applied to issues and recommendations presented here. 12

13 Recommendations of the Supporting Children in Child Welfare a sub-committee of the Child Abuse and Neglect Collaborative Recommendations for the Children s Division Reduce the number of cases each worker must manage. Address the root causes of turnover and take steps to eliminate those issues. Find additional ways to appreciate and recognize the good work of employees. Improve non-monetary (contingency) benefits for all staff. Move the Greene County offices to a safer, more accessible location. Continue the positive changes underway, e.g., the career ladder, mobile technology, and flexible work schedules. Recommendations for Policy-Makers and Legislators Increase the salaries of staff to compensate them for the nature of the work they perform. Spend time on the job with Children s Division staff to understand the challenges they face and to seek resolutions that enhance practice and conditions. Listen to and learn from frontline employees. Use the knowledge of staff to inform decisions. Continue the positive changes already underway. Recommendations for Citizen Involvement Invite Children s Division staff members to speak to your organizations, groups and committees to learn more about the foster care system and its needs. Support children and families served by Greene County Children s Division by becoming a respite or full-time foster parent. Volunteer with the Collaborative and its subcommittees. Volunteer with agencies that strive to prevent child abuse and neglect and to support children and families. Support efforts, locally and statewide, which will improve CD working conditions thereby improving services to children and families. Share the need for Children s Division workers and refer interested individuals to call the local office at The CAN Collaborative invites you to help write a successful ending to the story of how children in Greene County are protected and kept safe. Please visit for additional information. 13

14 APPENDICES 14

15 Appendix A: Survey Questions Job Satisfaction Survey JOB SATISFACTION SURVEY Paul E. Spector, Department of Psychology, University of South Florida. Copyright Paul E. Spector 1994, All rights reserved. 1=disagree very much; 2=disagree moderately; 3=disagree slightly; 4= agree slight; 5=agree moderately; 6=agree very much 1 I feel I am being paid a fair amount for the work I do There is really too little chance for promotion on my job My supervisor is quite competent in doing his/her job I am not satisfied with the benefits I receive When I do a good job, I receive the recognition for it that I should receive. 6 Many of our rules and procedures make doing a good job difficult. 7 I like the people I work with I sometimes feel my job is meaningless Communications seem good within this organization Raises are too few and far between Those who do well on the job stand a fair chance of being promoted. 12 My supervisor is unfair to me The benefits we receive are as good as most other organizations offer. 14 I do not feel that the work I do is appreciated My efforts to do a good job are seldom blocked by red tape I find I have to work harder at my job because of the incompetence of people I work with. 17 I like doing the things I do at work The goals of this organization are not clear to me I feel unappreciated by the organization when I think about what they pay me. 20 People get ahead as fast here as they do in other places My supervisor shows too little interest in the feelings of subordinates. 22 The benefit package we have is equitable There are few rewards for those who work here I have too much to do at work I enjoy my coworkers I often feel that I do not know what is going on with the organization. 27 I feel a sense of pride in doing my job I feel satisfied with my chances for salary increases

16 29 There are benefits we do not have which we should have I like my supervisor I have too much paperwork I don't feel my efforts are rewarded the way they should be I am satisfied with my chances for promotion There is too much bickering and fighting at work My job is enjoyable Work assignments are not fully explained

17 ProQOL, Version 5 (2009) Compassion Satisfaction and Compassion Fatigue When you [help] people you have direct contact with their lives. As you may have found, your compassion for those you [help] can affect you in positive and negative ways. Below are some questions about your experiences, both positive and negative, as a [helper]. Consider each of the following questions about you and your current work situation. Select the number that honestly reflects how frequently you experienced these things in the last 30 days. 1=Never 2=Rarely 3=Sometimes 4=Often 5=Very Often 1. I am happy. 2. I am preoccupied with more than one person I [help]. 3. I get satisfaction from being able to [help] people. 4. I feel connected to others. 5. I jump or am startled by unexpected sounds. 6. I feel invigorated after working with those I [help]. 7. I find it difficult to separate my personal life from my life as a [helper]. 8. I am not as productive at work because I am losing sleep over traumatic experiences of a person I [help]. 9. I think that I might have been affected by the traumatic stress of those I [help]. 10. I feel trapped by my job as a [helper]. 11. Because of my [helping], I have felt "on edge" about various things. 12. I like my work as a [helper]. 13. I feel depressed because of the traumatic experiences of the people I [help]. 14. I feel as though I am experiencing the trauma of someone I have [helped]. 15. I have beliefs that sustain me. 16. I am pleased with how I am able to keep up with [helping] techniques and protocols. 17. I am the person I always wanted to be. 18. My work makes me feel satisfied. 19. I feel worn out because of my work as a [helper]. 20. I have happy thoughts and feelings about those I [help] and how I could help them. 21. I feel overwhelmed because my case [work] load seems endless. 22. I believe I can make a difference through my work. 23. I avoid certain activities or situations because they remind me of frightening experiences of the people I [help]. 24. I am proud of what I can do to [help]. 25. As a result of my [helping], I have intrusive, frightening thoughts. 26. I feel "bogged down" by the system. 27. I have thoughts that I am a "success" as a [helper]. 28. I can't recall important parts of my work with trauma victims 29. I am a very caring person. 30. I am happy that I chose to do this work. B. Hudnall Stamm, Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). / or This test may be freely copied as long as (a) author is credited, (b) no changes are made, and (c) it is not sold. 17

18 Turnover Intention Questionnaire and Additional Questions Intention to leave the organization was measured using the three-item Turnover Intention Questionnaire (TIQ) adapted from the Michigan Organizational Assessment Questionnaire Intent to Turnover Measure. The TIQ is scored on a Likert scale ranging from 1 to 7, where 1 is strongly disagree and 7 is strongly agree. TIQ: 1. In the last year, I have thought seriously about leaving this job. 2. I often think about leaving this job. 3. I will probably look for a new job in the next year. Additional Questions: 1. I will probably look for a new job outside of this institution in the next year. 2. I will probably look for a new job outside of this field in the next year. 18

19 Appendix B: Description of Survey Participants Demographic Information Administrative Participants Direct Service Participants Age Average Age (n=15) (n=49) Range in years 28 to to 61 Tenure Average tenure (n=18) 6.63 (N=66) Range in years 4 to 35 1 to 34 Gender Male 3 (16.7%) 5 (7.6%) Female 15 (83.3%) 56 (84.8%) Race Prefer not to answer 0 5 (7.6%) White/Caucasian 16 (88.9%) 58 (87.9%) Latino/Hispanic 1 (5.6%) 1 (1.5%) Biracial/Multiracial 0 2 (3.0%) Prefer not to answer 1 (5.6%) 5 (7.6%) Highest level of education Master s degree 6 (33.3%) 16 (24.2%) Bachelor s degree 12 (66.7%) 48 (72.7%) Prefer not to answer 0 2 (3.0%) Marital Status Married 14 (77.8%) 43 (65.2%) Single 1 (5.6%) 3 (4.5%) Divorced/Separated 0 10 (15.2%) Widowed 3 (16.7%) 7 (10.6%) Prefer not to answer 0 3 (4.5%) 19

20 References American Public Human Services Association. (2005). Report from the 2004 child welfare workforce survey. Retrieved from Bavolek, S. J., & Rogers, M. S. (2012). The nurturing parenting programs are building protective factors in families. Retrieved from Child Welfare League of America. (2002). Child welfare workforce. Retrieved from Cowperthwaite, A. (2006). Cost of child welfare caseworker turnover (Grant #90CT112/02). Retrieved from Child Welfare Training Institute: Dorch, E., McCarthy, M. L., & Denofrio, D. (2008). Calculating child welfare separation, replacement, and training costs. Social Work in Public Health, 23(6), Doyle, Jr., J. J. (2008). Child protection and adult crime: Using investigator assignment to estimate causal effects of foster care. Journal of Political Economy, 116, Gelles, R. J., & Perlman, S. (2012). Estimated annual cost of child abuse and neglect. Chicago, IL: Prevent Child Abuse America. Hagele, D. M. (2005). The impact of maltreatment on the developing child. North Carolina Medical Journal, 66, Retrieved from Kaplow, J. B., & Spatz-Widom, C. (2007). Age of onset of child maltreatment predicts long-term mental health outcomes. Journal of Abnormal Psychology, 116(1), Retrieved from Putnam, F. W. (2006). The impact of trauma on child development. Juvenile and Family Court Journal, 57(1), Seashore, S.E., Lawler III, E.E., Mirvis, P.H., & Cammonn, C. (Eds.). (1983). Assessing organizational change: A guide to methods, measures and practices. New York, NY: John Wiley & Sons. 20

21 Spatz-Widom, C., & Wilson, H. W. (2009). How victims become offenders. In Children as victims, witnesses, and offenders (pp ). New York, NY: Guilford Press. Spector, P.E. (1985). Measurement of human service staff satisfaction: Development of the Job Satisfaction Survey. American Journal of Community Psychology, 13, Retrieved from Stamm, B.H. (2010). The concise ProQOL manual (2 nd ed.). Pocatello, ID: ProQOL.org. Stirling, Jr., J., & Amaya-Jackson, L. (2008). Understanding the behavioral and emotional consequences of child abuse. Pediatrics, 122, United States General Accounting Office. (2003). HHS could play a greater role in helping child welfare agencies recruit and retain staff. Retrieved from 21