state of oregon department of human services child welfare Staffing Study

Transcription

1 state of oregon department of human services child welfare Staffing Study

2 table of contents Executive Summary 2 1. Scope and approach of this staffing study Scope and deliverables Approach and basic principles applied 5 2 Current situation DHS has world-class aspirations Workload continues to increase Current capacity where caseworkers spend their time today 11 3 Detailing the current capacity gap Additional capacity required to do work that is not being done today 18 4 Potential options for addressing the capacity gap Short-term option: balancing workload across districts Case and office-related differences appear to affect workload discrepancies between and within districts New staffing standards could balance workload more effectively Potential combinations of levers that could stop negative workload cycles More efficient operations could reduce the gap significantly Enhanced procedures and consistent execution may help caseworkers increase impact Limited staffing increases could help close the gap Long-term continuous improvement could help prevent new negative cycles 33 5 Next steps 34 Appendix Sub chapters 3.2 to Additional capacity needed to meet additional 2008 requirements Additional capacity needed to raise quality of client service Additional capacity needed to relieve supervisors of caseworker tasks Additional capacity needed to reduce caseworker overtime 40

3 executive summary Over the past few years, caseworkers have had to deal with ever-increasing requirements for safely handling individual cases. As several recent reports 1 have noted, these demands have produced a stretched and exhausted workforce. As requested by legislature, the State of Oregon s Department of Human Services (DHS) commissioned a study on Child Welfare staffing to quantify this issue. DHS engaged McKinsey & Company, a global management consulting firm, to develop a workload-based Child Welfare staffing model. This report assesses the gap between DHS s current casework capacity and the workload required for effective Child Welfare casework today. It is intended as a reference for constituents and decision-makers during both initial discussions on the Child Welfare staffing issue and later decision-making sessions. McKinsey s findings indicate that capacity would probably need to be percent higher to meet federal standards, comply with current policies, and avoid continuous caseworker overtime. These numbers are based on an extensive diagnostic that combined direct observation, focus groups, and a time survey completed by more than 1,000 caseworkers more than 80 percent of all Child Welfare caseworkers in Oregon. The firm s independent analysis of the data then identified the difference between the required and available capacity. Going forward, DHS could consider several potential options for addressing this gap. While this report does not make specific recommendations, it does discuss these various paths. In the short-term, DHS could rebalance its resources across districts to achieve consistent staffing levels. The new staffing model developed as part of this study could help do this when appropriate. In the medium-term, the State of Oregon might use operational improvements to close a significant portion of the gap. DHS may also create a continuous improvement environment over the longer-term. Finally, the option of adding staff could be carefully considered where needed, taking into acount this option s expense to the State. DHS will develop the specific plan to achieve its goals as part of its current Transformation Initiative 2. 1 The so-called Holder report, Oregon Children, Adults, and Families Expert Review of the Safety Intervention System, authored by NRCCPS and ACTION for Child Protection (2005); and the Technical Assistance Report for the State of Oregon Department of Human Services, authored by L. Arnold, P. Devin, and S. Webster from NRCOI (2006) 2 DHS has recently launched a Transformation Initiative with the objective to become a world class health and human services organization, as stated in a project presentation (January 2008); in Phase 1 of this project, DHS is planning to develop strategic improvement plans for programs across the agency Child Welfare Staffing Study February

4 1 scope and approach of this staffing study

5 1.1 scope and deliverables To better understand how to cultivate safe, manageable workloads in Child Welfare, a potential staffing model was developed that would help identify and, ultimately, close the gap by using current and forecasted workloads. This report highlights the current state of the Child Welfare workload and the gap that appears to exist between available capacity and that required to meet federal standards, lessen overtime, and comply with current policies. It also describes the staffing model that has been developed based on the findings of this staffing study, and possible new standards resulting from it; the potential actions included are only initial ideas for DHS to consider when it later develops specific recommendations for closing the gap. Child Welfare Staffing Study February

6 1.2 approach and basic principles applied This study relied upon information provided by various parties, including the DHS Transformation Initiative team, DHS Children, Adult & Families (CAF) leadership, and Child Welfare field staff 3. Data came from the following sources: Direct observations based on field visits to 5 diverse districts, which used all-staff meetings and direct observations/job shadowing to identify location-specific issues 4 focus groups with more than 50 caseworkers and supervisors that uncovered issues for different case types and employee roles. A detailed time survey that more than 1,000 caseworkers completed for three representative working days between December 13, 2007 and December 20, The survey yielded detailed information on average time spent on activities and on differences by case types and regions/ branches/individuals. The following principles, listed below, tried to maximize the likelihood that the study s results reflected the true needs of caseworkers clients (i.e., children, parents), DHS employees, and other DHS stakeholders. Workload assessment would reflect the actual work needed to meet key outcome targets, above and beyond the work that gets done today. Core analyses would focus only on casework and casework support. General support staff and central office would only be considered as ratios of casework staff. Crucial differences affecting workload e.g., office location (rural/ urban) or case complexity (in home/sub care etc.) would be examined. Calculations would include down time for caseworker decompression, training, and new employee ramp-up. An activity-based approach, rather than a case-based approach, was chosen. It painted a detailed picture of how much time individual caseworkers spent on each task. This information helped identify the time caseworkers spent on activities and how these amounts compared within and outside of DHS. DHS may be able to apply the findings to different types of cases as appropriate. 3 Some of the data provided by these and other sources were not independently verified as part of this study. Child Welfare Staffing Study February

7 2current situation

8 2.1 dhs has world-class aspirations DHS recently launched a Transformation Initiative to become a world class health and human services organization 4 in every area, including Child Welfare. Achieving this goal means more than meeting federal standards DHS wants to provide consistent world-class service and outcomes to all its clients. DHS needs to improve its performance to meet this aspiration in Child Welfare. Child Welfare s ranking was below median in 3 out of 4 composite performance measures (Exhibit 1) in other words, below world-class performance on the Child and Family Services Report (CFSR) 5, which compared Child Welfare administration outcomes across all U.S. states. The Final Report for the second round of CFSR for Oregon, published in early February 2008, found DHS Child Welfare to be in substantial conformity with national standards for none of the 7 client outcomes measures and only 3 of 7 systemic factors under review. Exhibit 1 These results reflect the issues that Child Welfare has experienced in capturing and sustaining improvements. Although CAF temporarily met some of the targets negotiated in , its current performance is substantially below most of the goals. For example, only about 55 percent of children in foster care are reunified within 12 months 21 points below the negotiated target of 76 percent. Similarly, around 10 percent of children re-enter foster care within 12 months, 1.4 points above the goal of 8.6 percent. 4 DHS Transformation Initiative Project Presentation, January Second round of CFSR 6 Negotiated with federal Child Welfare administration after the 2001 first round CSF reviews 7 Final Report: Oregon Child and Families Services Review, Executive Summary, February 2008 This trend was confirmed by CFSR s Final Report: Oregon Child and Families Services Review for its second round 7. It found that DHS Child Welfare is not in substantial conformity with national standards for any of the 7 client outcome measures. These include Safety, Permanency, and Children s Well Being. DHS is in substantial conformity with only 3 of 7 systemic factors, including the Statewide Information System; Case Review System; Service Array; and Foster and Adoptive Parent Licensing, Recruitment, and Retention. Child Welfare Staffing Study February

9 2.2 workload continues to increase In 2005 and 2006, two expert reports 8 stated that escalating workload had stretched caseworkers and possibly produced poor performance. Both documents also highlighted staff s frustration with inadequate resources and inefficient processes. The reports focused on the caseload-based approach to staffing as one of the primary reasons for the problems. This method allocates a certain number of cases to each caseworker; it assumes that every case of a certain type requires about the same amount of work and that this workload does not change over time. It appears that neither assumption is completely accurate. The time activity survey conducted for this study supported the assertion made by many Child Welfare practitioners that the amount of work varies significantly between cases, even within the same case type 9. In addition, the amount of work a particular case demands changes over time, with certain policies and procedures being changed. Regulatory changes may in some cases require more time from caseworkers. Some safety requirements and federal regulations have raised workload per case in Child Welfare. For instance, in 2007 the new Oregon Safety Model introduced an integrated, continuous assessment of children s safety. It changed nearly all major Child Welfare processes and procedures and increased workload in several areas, e.g., by increasing the share of 24-hour response cases for Child Protective Services. 8 The so-called Holder report, Oregon Children, Adults, and Families Expert Review of the Safety Intervention System, authored by NRCCPS and ACTION for Child Protection (2005); and the Technical Assistance Report for the State of Oregon Department of Human Services, authored by L. Arnold, P. Devin, and S. Webster from NRCOI (2006) 9 See chapter Child Welfare Staffing Study February

10 State legislation that was passed in 2007 and took effect in January of 2008 will probably also increase workload further for some Child Welfare cases 10. The legal changes implied by Senate Bill 412 require that all relevant parties be notified of child neglect/abuse reports for children currently in foster care. Senate Bill 414 raised reporting and visitation requirements. House Bill 3113 demands more comprehensive reviews of certified child care facilities and the use of higher standards the same as those for foster care. Continuously increasing workload may drive two negative cycles that could result in suboptimal client outcomes (Exhibit 2). How could DHS stop the negative cycles in the short or medium term? Exhibit 2 10 Bills translate into Oregon Revised Statutes (ORS); Senate Bill 412 revises ORS chapter 419B.015; Senate Bill 414 revises ORS chapters , 419A.004, 419B.090, 419B.185, 419B.192, 419B.337, 419B.349, 419B.368, 419B.443, 419B.449, 419B.470, 419B.476, and 419B.498; House Bill 3113 revises ORS chapter 419B.020 Child Welfare Staffing Study February

11 First, the workload inflation cycle (left hand cycle in Exhibit 2) could result in cases staying longer in the system or reentering it later on which could increase workload even more and fuel the cycle. Higher workloads can mean caseworkers have less time to spend on each case; as a result, they may become less effective. The second cycle - worker frustration (right hand cycle in Exhibit 2) depicts the process where higher workloads could increase frustration and turnover, producing a less experienced workforce that may have trouble handling workload effectively. If this is the case, workload may rise again. A third negative cycle may also exist outside of DHS. When negative incidents happen, public media often cover them heavily. The legislature may react by adding policies and procedures to prevent similar issues in the future. These changes while making children in Oregon safer, which is invaluable may in some cases increase workload per case not only in cases where the risk of similar future incidents exists but also in other cases. This report will address two fundamental questions about these cycles: How could DHS stop the cycles in the short or medium term? How could DHS prevent them from starting up again? Because Oregon s Child Welfare capacity and workload need to be balanced to stop the cycles for any length of time, the rest of this report will focus on capacity vs. workload and the resulting capacity gap that DHS faces. Child Welfare Staffing Study February

12 2.3 current capacity where caseworkers spend their time today The comprehensive time activity survey, completed by more than 1,000 of DHS Child Welfare caseworkers, helped determine where caseworkers and casework support staff spend, or don t spend, time today. The primary finding related to direct client contact: caseworkers spend less than 30 percent of their time in contact with clients or collateral contacts directly related to cases. To find out what might be producing this result, Child Welfare casework was divided into 5 basic processes or roles. Focus groups helped identify detailed activities for each process (Exhibit 3). Among these roles, permanency/ongoing work accounted for 60 percent of overall case-related time spent today. CPS and foster home certification were next, while screening and adoption had smaller shares. Permanency/ongoing work accounted for 60 percent of overall case-related time spent today. Exhibit 3 The time survey, together with data from HR, revealed that caseworkers were available for case-related work only 70 percent of the time, or less than 6 hours per day. The remaining 30 percent is non-available time. Non-available time includes vacancies (4 percent), sick leave (3 percent), other paid and unpaid leave (8 percent), paid breaks (6 percent), paid on-call time (1 percent), training (2 percent), and other non case-related work (6 percent) such as general staffing or general administration and communication. Child Welfare Staffing Study February

13 Within the available time (70 percent) spent on case-related activities, over half was taken up in case-supportive activities 41 percent, to be exact. On average, less than 1 hour and 15 minutes per day was found to be spent communicating directly with clients (Exhibit 4). The time activity survey, together with data from HR, revealed that caseworkers are available for case-related work only 70 percent of their time, or less than 6 hours per day. Exhibit 4 The other activities, particularly indirect client service, are necessary and important; however, opportunities may exist to reduce time spent on them. Several possibilities emerged from the diagnostic: CPS workers spend twice as much time traveling to/from and waiting in court as they do actually attending hearings Permanency workers spend about as much time on clerical work per day as in face-to-face contact with children For every hour adoption workers spend assessing adoption homes, they spend over 3 hours preparing home study packets and updating paperwork. Child Welfare Staffing Study February

14 Oregon s caseworkers spent less time on direct client contact than any of the other states that recently implemented Child Welfare staffing studies. These factors mean that Oregon s caseworkers spent less time on direct client contact than any of the other states that recently implemented Child Welfare staffing studies (Exhibit 5) even Alaska, which had significantly higher nonavailable time. Exhibit 5 Large differences also existed in various district time profiles. For instance, the time spent on client and collateral contacts ranged from 24 to 33 percent. Unearthing the reasons for these disparities may identify both issues and best practices. Child Welfare Staffing Study February

15 3 detailing the current capacity gap

16 The time survey in the diagnostic showed that caseworkers spent most of their time on administration and supportive work. As a result, caseworkers felt they did not have enough time to work directly with their clients and get the work done that is required to effectively support the safety and well being of children in Oregon a feeling the focus groups and direct observations in this study confirmed. This study quantified the gap between available and required capacity 11 for highquality Child Welfare casework. It was estimated to be between percent 12 today. DHS would need to address this disparity to meet federal standards, comply with current policies, and avoid continuous overtime. This section outlines the different components of the gap. More details on specific items are available in the Appendix, which starts on page The calculation is based upon current capacity at 100 percent, with current capacity defined as all the work that current employees get done within standard 8 hour days. The spillover work that results in overtime today was added on as part of the gap between current capacity and actual workload. Vacant positions were excluded, double-filled positions were counted as two resources, and overtime was interpreted as a temporary and artificial increase in actual capacity. 12 Because the team used percent of current capacity to measure the gap, DHS capacity gap may appear smaller than those in other staffing studies, which usually talk only about additional headcount. For example, the staffing study for the State of Washington published in November 2007 reported a gap of up to 70 percent casework staff. Child Welfare Staffing Study February

17 Exhibit 6 depicts the five factors that are considered as part of the gap, including the capacity required to: 1) Perform work not getting done today (17-23 percent): Some of the work required to achieve federal performance targets on key outcome measures does not get done by DHS Child Welfare today. 2) Meet additional 2008 policy requirements (1-2 percent): The laws that went into effect in January 2008 may add further workload. (page 37) 3) Raise service quality (3-4 percent): Some of the key performance measures that lack minimum quality standards could actually result in lower levels of client service, e.g., the target about meeting face-to-face with children every 30 days could produce sessions that are too short because the caseworker is trying to see every child within the time period. (page 38) 4) Relieve supervisors of current caseworker tasks (0-3 percent): Supervisors spend a significant portion of their time on caseworker tasks. Extra caseworker capacity may be required to relieve them of this work if it is simply spillover casework due to lack of current caseworker capacity. (page 39) 5) Reduce caseworker overtime (3-5 percent): Caseworkers regularly work significant overtime hours, both paid and unpaid. Extra capacity would be required to reduce these numbers. (page 40). Five factors contribute to a gap between current and require capacity. Exhibit 6 Child Welfare Staffing Study February

18 This report estimates the gap in terms of workload rather than additional FTEs required. This approach is a departure from other state reports, which have tended to report the gap in terms of people, not work. A study that used FTEs would result in a higher number for the gap since every 1 percent workload gap is equivalent to a 1.4 FTE gap. This increase reflects the fact that each additional employee only spends about 70 percent of their budgeted time on case-related work. This study took a workload-based approach because additional personnel may only be one part of the solution DHS chooses to pursue it may also address process efficiency, tools, and requirements. If DHS were to use just staff to close the 24 to 37 percent gap, it would need 35 to 53 percent more caseworkers. The rest of this section provides an example of the methodology used to quantify the gap and describes the largest capacity gap that needed to perform work that is not being done today and that is necessary if Child Welfare is going to comply with current policies. Detailed discussions of the other four factors are included in the Appendix. Child Welfare Staffing Study February

19 3.1 additional capacity required to do work that is not being done today The first part of the capacity gap, Perform work not being done today, deals with required tasks that are not being done by the workforce today. The estimates indicate a larger increase in capacity than any other factor - 17 to 23 percent. Examination of how Child Welfare performed on eight critical outcome measures and how much time caseworkers spent on each was the first step in estimating the time required to achieve target performance 13. Those measures are the highest priority targets for Child Welfare on the CAF dashboard today that DHS is not in compliance with. They cover policies related to CPS work (timeliness of CPS response, timeliness of CPS assessment); permanency/ongoing work (face-to-face contacts with children/adults every 30 days); outcomes of permanency/ongoing, certification, and adoption work (share of children reunified within 12 months, share of adoptions completed within 24 months, repeat maltreatment within 6 months, foster care re-entry within 12 months). As performance improves over time, estimates of additional time could easily be adjusted to reflect this change. Although this method may miss some work that is not critical and produce a smaller estimate of the total gap, this approach seems to offer a conservative but credible estimate. Exhibit 7 shows the estimated additional capacity needed for caseworkers to do the work they are not performing today and thus at least theoretically have a chance to comply with the eight critical performance measures. Currently, Reduce repeat maltreatments seems to require the largest increase in capacity at least 5 percent of total capacity. Four other targets also demand significantly more capacity: response and assessment timeliness, face-to-face parental contact every 30 days, and reunification within 12 months. Examination of how Child Welfare performed on eight critical outcome measures and how much time caseworkers spent on each was the first step in estimating the time required to achieve target performance. Exhibit 7 13 Many of the cases not worked on today which may be the harder ones - may require more work. One example is face-to-face visits, where 100 percent compliance may not be possible. Some clients could avoid the caseworker or could not be able to meet during the caseworker s normal working hours. To deal with this, average time spent per case was increased by 50 to 100 percent over current averages for the required capacity estimate. Child Welfare Staffing Study February

20 4 potential options for addressing the capacity gap

21 This section offers three possible paths that DHS can explore as it develops specific recommendations for closing the capacity gap. In the short-term, DHS may want to consider several methods for balancing workload across districts. In the mediumterm, it could examine methods for improving operations. As it moves into longerterm priorities, it could start to build the type of organization that can constantly and rapidly adapt to ever-changing requirements. Child Welfare Staffing Study February

22 4.1 short-term option: balancing workload across districts DHS may want to consider balancing capacity and workload more effectively both across and within districts. Appropriately matching capacity with workload could reduce the risk of critical incidents due to overstretched workers and improve performance in districts with particularly high workload today. Mapping each district s current performance against its workload revealed a strong correlation: as workload decreased, performance increased. Exhibit 8 shows this relationship. Each dot represents a district. The dot s height shows the district s performance in terms of Child Welfare dashboard measures; how far it is to the right indicates relative workload size compared to current staffing situation. The line indicates that as workload increases (i.e., moves to the right of the chart) performance tends to fall (i.e., moves to the bottom of the chart). Matching capacity with workload could reduce the risk of critical incidents. Exhibit 8 Only one district (number 3) shows both high performance and relatively high workload. Interviews with CAF leadership revealed that managers in this district tend to focus more on achieving dashboard performance outcomes than some of their colleagues in other districts. Two questions emerge: First, why has similar performance eluded other districts? Second, do improvements in the current dashboard measures imply better client outcomes and if not, what measures would better capture desired client outcomes? Child Welfare Staffing Study February

23 4.1.1 case and office-related differences appear to affect workload discrepancies between and within districts Understanding exactly how specific case, office, and process stage characteristics affect workload can help DHS balance workload across and within districts. A statistical technique called multiple regression pinpointed how various officeand case-related factors (e.g., number of cases, type of cases, office location) affected the time caseworkers would need to spend on a case in the various process stages (e.g., CPS, adoption). This approach revealed that differences in office or case characteristics can change workload in important ways. Exhibit 9 shows how several specific factors influenced the amount of time caseworkers devoted to a case. Differences in office or case characteristics can change workload in important ways. Exhibit 9 Child Welfare Staffing Study February

24 Different variables had a bearing on specific stages, including: CPS: Workload increased most based on court involvement and whether the child was in sub care; the ratio of SSAs to caseworkers in a district decreased workload twice as much as any other variable. Permanency/ongoing: Workload decreased most if the child was in sub care; this was the strongest factor in either direction. Foster home certification: Workload increased most based on the share of general applicant certifications, although the share of bilingual homes and special placement certifications were also important. Adoption: Workload increased based on the share of general adoption applicants. Other results revealed some unexpected effects across stages. For instance, children with disabilities or addictions lowered workload in the CPS stage but raised workload more than other cases in permanency/ongoing work. A high ratio of SSAs to caseworkers significantly reduced average workload for CPS staff. However, it had no significant influence for permanency/ongoing caseworkers. One potential reason could be that there may be enough SSAs today to support the relatively stable permanency/ongoing casework in all districts, while only some districts may have enough SSAs to cover unexpected new CPS cases effectively. Exhibit 9 shows only those variables that had a significant influence on workload. Other variables, ones that were tested but that did not have a significant effect, are not displayed. For example, permanency/ongoing workload was not affected by bilingual clients or families. On the other hand, average office size, as a proxy for rural versus urban branches, does have a significant workload impact for permanency/ongoing workers: the larger the office, the less workload per case. Child Welfare Staffing Study February

25 4.1.2 new staffing standards could balance workload more effectively The information in section helped create a workload-based staffing model that generated a new set of staffing standards. These standards can be expressed as caseload ratios for each of the five different stages of Child Welfare casework. The new ratios are summarized in Table 1, along with the current (national) standard and actual ratios. The actual ratios are those in effect for current capacity, based on the time survey. Case ratios are defined as follows: Screening: Number of screening calls to number of screeners CPS: Number of CPS plans and referrals to number of CPS workers Permanency/Ongoing: Sum of number of children in foster care, number of children in residential treatment, and number of in-home cases to number of permanency/ongoing workers Foster home certification: Number of open foster care providers to number of foster certification workers Adoption: Number of adoptions completed during a 12-month period to number of adoption workers. The first row of Table 1 shows the caseload ratios approved in July 2007, which conform to national standards. The current staffing model uses these caseload ratios to calculate the number of caseworkers required across the different roles in each branch. The second row shows the actual caseload ratios based on staff resources today, as measured by the activity survey. The ratios differ for two reasons: First, the overall number of staff is not exactly equivalent to the number demanded by the standard ratios; and second, the relative distribution of actual time spent between roles differs from the standard distribution. Today s lower ratios for screening and foster certification imply that caseworkers across the state seem to spend more time in these areas than the federal standard ratio would predict; today s higher ratio for adoption implies that caseworkers spend less time here than would be expected. The third row shows the caseload ratios after considering the required capacity increase from the identified workload gap of at least 24% 14. All of the ratios have fallen (i.e., more resources may be needed). However, these caseload ratios should be considered a theoretical number for the current point in time, as implementing those would be prohibitively expensive. As discussed in the next section (4.2), efficiency measures could also help bring caseload ratios in line with federal standards. Table 1 - Caseload Ratios Number of cases of each type per FTE Type of case Screening CPS Permanency/ Ongoing Foster Certification Adoptions Current model (national standard) Capacity today % capacity gap See chapter 3; gap of 24 to 37 percent between current capacity and required workload Child Welfare Staffing Study February

26 The model that generated these standards was based on the number of caseworkers currently needed at each Child Welfare branch location. It incorporated multiple factors, including: Individual branch caseloads Activity times measured by the workload survey (for work done today) Variations in office and case characteristics that influence workload. Extra work required to complete casework to a satisfactory level (e.g., that needed to meet present and future policy requirements, achieve best practice service, relieve supervisors of caseworker duties, and reduce workers overtime) Time available by workers to do casework Two points are important to note with regard to the new case standards. First, in a workload-based staffing model, the ratios are the result of the workload assessment and will change to reflect new realities in the field. As the capacity gap starts to close, many of the model s input factors will shift and create new staffing ratios. Second, the model projects only Child Welfare caseworkers. It uses ratios to casecarrying staff to calculate other staff levels, including office support staff and supervisors. Central office staff was not included in this study or in the model. Child Welfare Staffing Study February

27 4.2 potential combinations of levers that could stop negative workload cycles Improving operations efficiency and reviewing procedures for effectiveness in their execution are two of the first steps DHS could take in the medium-term. Although some staffing increase may also be required, these actions could provide relief while other long-term improvements start to take hold. A broad range of direct and indirect levers may potentially improve Child Welfare outcomes and reduce workload per case (Exhibit 10). DHS may examine many of these as it identifies specific ways to free capacity and raise service quality. Improving operations efficiency and reviewing procedures and policies for effectiveness are the first two steps DHS could take in the medium term. Exhibit 10 A preliminary best case estimate of operational improvement s impact indicates that DHS could potentially reduce overall workload by about 14 percent. These estimates are based on DHS field observations and McKinsey s Service Operations experience in other transformations in the corporate, government, and non-profit sectors. The numbers could grow or shrink as DHS refines ideas and tests specific hypotheses over the next few months. Capturing this improvement may require that DHS consider raising operational efficiency and reducing workload requirements in procedures, either through streamlining of internal procedures or more consistent execution. The remaining capacity gap of at least 7 percent would possibly need to be closed by increasing staff (potentially by about 10 percent), assuming constant Child Welfare case demand The current Child Welfare casework computer system Child Welfare Staffing Study February

28 If DHS captured 14% efficiencies, caseload ratios could increase back to a level close to current capacity (Table 2). However, because caseload ratios are an output of a workload-based staffing model, it is not possible to currently forecast the likely ratios after the transformation. They will depend on the specific efficiencies and policy changes DHS decides to implement in specific roles. The last row in Table 2 should therefore be considered exemplary only; it shows the potential caseload ratios after the 14% efficiency gains are realized assuming that those efficiency gains are distributed equally across all roles, which may not be the case. Table 2 - Caseload Ratios Number of cases of each type per FTE Type of case Screening CPS Permanency/ Ongoing Foster Certification Adoptions Current model (national standard) Capacity today % capacity gap After 14% efficiencies Child Welfare Staffing Study February

29 4.2.1 more efficient operations could reduce the gap significantly Reducing administrative time could add up to 40 minutes to a caseworker s day on average. Documentation/clerical work, which could reduce workload by up to 5 percent, is the biggest potential timesaver (Exhibit 11). Enhancing the computer system to enable accurate and automatic pre-filling of FACIS forms would be one way to do this. Lowering travel/logistics/waiting times could add 10 minutes. Working with courts to improve hearing appointment accuracy or investing in a limited number of mobile GPS systems are two of many potential ways to capture this opportunity. The rest of the areas could free up another 40 minutes a day on average. In addition, it may be possible to improve even those activities that are at the core of Child Welfare work, such as communication with clients and collaterals. While more time should potentially be invested in these areas, caseworkers may be able to use that time more effectively. For example, good preparation of collateral meetings could reduce the time required for the meeting and produce better outcomes. Documentation/clerical work, which could reduce workload by up to 5 percent, is the biggest potential timesaver. Exhibit The current Child Welfare casework computer system Child Welfare Staffing Study February

30 Other significant opportunities including sharing best practices and improving recruiting - have also been identified. Sharing good or best practices across individuals and districts could increase available casework time. For instance, the lowest scores for various elements in non-available time (e.g., unpaid leave, vacancy, other leave, and other non case-related work) are significantly below the average ones across districts (Exhibit 12). If DHS could move toward the lower numbers it could increase capacity significantly even if it were not possible to achieve the minimum in every case. Other significant opportunities including sharing best practices and improving recruiting - have also been identified. Exhibit 12 Child Welfare Staffing Study February

31 Exploring time investment across the life of a case may also present opportunities to improve client outcomes, save time, and potentially increase capacity. For example, by investing more time earlier in the foster parent recruiting process DHS may be able to lower the time caseworkers need to spend working with clients afterwards at same or better outcomes. Caseworkers today only take about 0.5 percent of total casework time to recruit foster parents, but spend more than 30 percent of total time to work with children in foster care (Exhibit 13). This division of labor has resulted in a pool of foster parents that many caseworkers feel is too small. It can also create matches between children and foster parents that are not ideal, sometimes compromising placement stability or producing long transportation times from the foster home to the child s home school. These conditions indicate that an initial investment into foster parent recruiting may be able to reduce time required for later casework. The investment could include direct foster parent recruiting efforts by DHS and/or community work to encourage community partners to recruit foster parents. If DHS could leverage its volunteers and community resources more effectively, it may also be able to improve other areas. By investing more time earlier in the foster parent recruiting process DHS may be able to lower the time caseworkers need to spend working with clients afterwards at same or better outcomes. Exhibit 13 Several other hypotheses, which still need to be tested, may also reduce workload. A few of them could potentially: Achieve better client outcomes by aligning Child Welfare casework more closely with central office and other DHS programs, e.g., more crossreferencing to self-sufficiency programs Increase efficiency and effectiveness through more comprehensive and regular training for caseworkers of all tenures Improve process efficiency by creating more specialization among caseworkers, not just at the branch and/or district level Lower workload by adding more legal support staff to help caseworkers prepare for court/crb hearings and coordinate with attorneys Child Welfare Staffing Study February

32 4.2.2 enhanced procedures and consistent execution may help caseworkers increase impact Reviewing internal procedures could potentially enable DHS to identify candidates for streamlining, rework, and elimination. Some internal procedures may contradict policies or each other; others may be relevant to a smaller set of cases. Consistent execution is also a lever DHS could examine as it works to reduce policy-related workload. Child Welfare field managers agreed that the Oregon Safety Model could ultimately reduce overall workload for caseworkers and drastically improve client outcomes after full implementation. However, they also observed that caseworkers haven t stopped doing things that are no longer required under the new policies. The focus groups confirmed this point; some experienced workers had trouble distinguishing between laws, internal policies and procedures, and local habits. Although the last are everywhere, they are not a required part of Child Welfare casework. As DHS moves forward, it could potentially free up capacity by identifying and removing unnecessary work that is being done locally today, although it is not required by procedures or policies. Child Welfare Staffing Study February

33 4.2.3 limited staffing increases could help close the gap Additional caseworkers would probably be needed to close part of the gap. This is a relatively costly approach as closing a 7 percent workload gap would require about 10 percent investment in FTEs caseworkers are currently only available for 70 percent of their time (Exhibit 14). Other options (as outlined above) may be more efficient. Additional caseworkers would probably be needed to close the gap that remains after processes become more efficient and requirements are changed. Exhibit 14 Child Welfare Staffing Study February

34 4.3 long-term continuous improvement could help prevent new negative cycles Once DHS stops the negative cycles, it may need to continue to improve and work closely with a legislature that is sensitive to the impact its decisions have on the Child Welfare workload. In this way, both groups could anticipate workload changes and work together to sustain the capacity/workload balance over time. DHS Child Welfare could continue to raise efficiency and reduce workload year over year. Accomplishing this may require a shift from the question of how can we get more resources? to how do we require fewer resources for better client outcomes?. Pursuing this mindset may enable DHS to integrate the additional workload that new legislation can create while avoiding potential service disruptions sustainably. By updating the workload-based staffing model developed as part of this study regularly, DHS could use it to highlight its improvements and to demonstrate new laws effect on workload. Annual repetitions of the time survey could help DHS show how caseworkers have shifted their time to other tasks (e.g., direct client contact). Sharing these results may provide a positive message to stakeholders as well as motivating staff and reinforcing successful behaviors. Child Welfare Staffing Study February

35 5 next steps

36 Moving forward, DHS plans to evaluate the various improvement ideas for closing the capacity gap in Child Welfare. Specific ideas are being developed and tested in Transformation Initiative Phase 1. It is not possible to assess how much of the gap can be closed through efficiency and effectiveness improvements until this step is complete. This will probably take until June; implementation will follow, with impact ramping up gradually over up to 3 years. Given that the transformation could end up changing the entire Child Welfare system significantly, the staffing model may need to change. For instance, the model developed for this report does not assume any shifts in the number of support staff in the field or central office. A holistic system diagnostic may reveal that it is better to have more or less support in certain places. It is even possible that DHS, as a world-class organization, may require some entirely new roles. For instance, a recent internal DHS report on psychotropic medication for children in foster care 17 recommended the introduction of specialist caseworkers to provide expert support on mental health questions. This may be only one of many areas where increased specialization could be beneficial. Whether or not the creation of such roles makes sense, and on what level (branch/district/state), will have to be answered in the next phase of the DHS Transformation Initiative. 17 Draft Report on Psychotropic Medications for Foster Children, authored by DHS Medication Management Workgroups; January 28, 2008 Child Welfare Staffing Study February

37 appendix sub chapters 3.2 to 3.5 Chapter 3 of this document outlined five factors that contribute to the estimated percent capacity gap in Child Welfare; it discussed only the largest capacity gap in detail that needed for caseworkers to do work they are not doing today to comply with current policies. Detailed discussions of the other four factors are below.

38 3.2 additional capacity needed to meet additional 2008 requirements The increases needed to deal with the new 2008 bills are not nearly as large as those required to comply with current policies; nevertheless, they raise workload by another 1 to 2 percent. The increases needed to deal with the new 2008 laws are estimated to be not nearly as large as those required for current policies; nevertheless, they could raise workload by about 1 to 2 percent (Exhibit 15). Two items related to Senate Bill 414 appear to be behind most of this change: the need for more frequent visits and for proof of diligent effort to reunify children in sub-care with their biological parents in court. Exhibit 15 An expert group helped estimate this additional workload by refining analyses DHS did for the legislature during the last legislative session. Many of the time estimates are also based on field trials conducted by field staff management. Future legislative or policy requirements could easily be incorporated into the newly developed staffing model, which would then estimate how much additional workload they would generate. Child Welfare Staffing Study February

39 3.3 additional capacity needed to raise quality of client service While it is difficult to define quality in casework, it seems important to set minimum standards that provide benchmarks and common sense guidelines. Meeting performance targets alone may not be enough if an appropriate level of client service and quality is not maintained. In this context, one potentially problematic performance measure is frequency of face-to-face contacts. Caseworkers could achieve high performance by doing very short visits only. DHS leadership, when considering this situation, decided to introduce an additional measure that assessed quality of client interaction, not just frequency. Although no formal research studies were found that recommend a minimum reasonable duration of face-to-face contacts, there are several recommendations on content areas that should be covered for an effective contact. Based on these recommendations, DHS Child Welfare experts estimated that most permanency/ ongoing work visits need to last at least 60 minutes to be effective. Currently, about 70 percent of all DHS permanency/ongoing contacts last less than 60 minutes. Some contacts may be shorter for a good reason: for example, a 60 minute contact with just a newborn would probably not be appropriate. However, the fact that the vast majority of contacts are shorter than 60 minutes today raises the question whether all clients receive sufficient quality time today. Raising the quality of DHS caseworker/client interactions to world-class levels may potentially demand an investment of additional time in face-to-face meetings. The DHS expert group suggested a standard of 60 minutes for permanency/ ongoing work as well as adoption work visits. The group recommended 90 minutes for foster home certification because workers only have to visit families once every 3 months. Meeting these standards would increase total workload by around 3 to 4.5 percent: between 2.4 and 3.7 percent more time for permanency/ongoing work and between 0.5 and 0.7 percent for adoption and foster care work. Child Welfare Staffing Study February

40 3.4 additional capacity needed to relieve supervisors of caseworker tasks Supervisors currently spend about 18 percent of their time on caseworker tasks. If this time was spillover casework rather than time well spent on particularly difficult cases, this time would not be available for the supervisor role and may actually reduce the effective supervisor to caseworker ratio of 1:7 to about 1:8. Some of the casework activities performed by supervisors are administrative; others focus on client contact but in a caseworker role. For instance, supervisors spend an average of 19 minutes per day on case-related paperwork and clerical work, and 15 minutes on travel and logistics compared to only 17 minutes in direct contact with clients or in court. They also spend 13 minutes per day preparing and providing training for foster parents and adoptive parents. Over the next few weeks, DHS could explore whether case complexity or limited caseworker time drives supervisor time on cases. It may be that supervisors focus their casework support on extremely difficult and critical cases where their time is well spent. For this reason, the estimate ranges from 0 to 3 percent the additional workload that caseworkers would have to carry if supervisors spent no time on caseworker tasks. Child Welfare Staffing Study February