Man Wearing Mask
by Mónica Gutiérrez, MSW
Under current pandemic conditions, social workers in communities throughout our country are forced to incorporate modern methods for serving communities and clients. Shifting to online home visitation, telehealth, and telebehavioral health is proof that we can make 21st-century changes to serve our clients and communities. Despite these subtle shifts, the profession has not yet fully integrated innovative methods to reach individuals who have historically experienced marginalization. These communities experienced significant health vulnerabilities prior to the pandemic, and their risks are now exacerbated. We must do better and embrace innovative social work practices to serve our communities.
One example of a large-scale social service agency that has felt the impact of COVID-19 is the U.S. child welfare system. The pandemic has revealed the current policies that guide this system are flawed and cannot withstand this unprecedented disruption in services. Last year, 3.5 million children were involved in a child protective service investigation. Of that, 437,283 entered the foster care system. More than half of the children who enter the system are children of color with an average age of eight years old (Children’s Bureau, 2018a). Most remained in state care for close to two years on average, and 5% lived a life of uncertainty in foster care for five or more years (Children’s Bureau, 2018b). These statistics should provide us with the urgency needed to adapt modern social work methods to meet the needs of the community for the well-being of future generations.
As a bilingual and bicultural Latina social worker, I understand the vital role of community connectedness and kinship in the lives of children and families, and that this connectedness is essential to our survival in and out of various social systems. This lens has guided my work in various agencies throughout my career. Most prominent was my role as a child protective services case manager, where I navigated multiple institutions (i.e., courts, law enforcement, review boards, schools, mental health services, community-based agencies, and housing) to prevent, assess, and resolve child abuse. I maintained a caseload of 40 children ranging in age from six months to 10 years. The caseload was well above the recommended number of cases endorsed by the Child Welfare League of America, along with the Council on Accreditation, which suggests a preferred caseload in the range of 12 to 15 children per worker (2004). The unmanageable workload was compounded by unrealistic case plans for parents. It was not uncommon to receive a frantic call from a parent trying to comply with the required case plan needed to reunify with their child. They were frustrated that state-approved providers for behavioral and mental health services were only available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m., which was in direct conflict with the mandate to maintain stable employment. Any effort to advocate for flexibility in the service plan whenever safe and possible was denied.
By my second year in the role, I was experiencing fatigue and soon came to realize I was burnt out. It was time to move on and actively engage in systems change. For several years, I internalized my inability to keep up with my caseload as a personal defeat. Only later did I realize that it was the system and policies that failed, thus jeopardizing the safety and future of communities and children experiencing the most vulnerability. I remain appreciative of past and present case managers who, like myself, have spent time and energy to transform a system where change is not always welcome. I think back fondly on my time in this role, and wonder….
What if the social work profession had embraced the use of online home visitation, telehealth, and telebehavioral health to assist families as a prevention tool?
What if parents participating in services had had access to telehealth or telebehavioral services to fulfill the requirements for reunification? Would parents and their children have had different outcomes (higher rates of reunification or adoption)? How might less time in the foster care system have affected their adult lives, and the lives of their future children?
What if we shifted from a reactionary to a proactive child welfare system that helps to address the structural systems that drive contact in the first place (e.g., unemployment, structural and institutional racism, addiction, poverty, and homelessness)? One that addresses and acknowledges the historically oppressive events that have produced inequitable outcomes for generations of families?
Although we do not yet have a holistic snapshot of social work post-pandemic, the profession has reached a tipping point where we have the opportunity to advance social work and create the needed tools to innovate the profession. A 21st-century social work toolbox should include the following:
- Innovative Case Planning Practices. We should innovate case plans and services, which could potentially result in differential outcomes. We need just-in-time adaptive case plans that meet clients where they are instead of the standard service model given to all families when they begin services. The prescribed case plan provided to parents typically does not align with their most urgent needs. Consideration for the individual needs of a family could potentially promote higher participation in the case plan and, in turn, lessen the time a child spends in care. These personalized touchpoints should occur in realtime to allow case managers and service providers the ability to intervene quickly and effectively. These touchpoints do not need to be in person. This pandemic has proven the value of telehealth and telebehavioral services, and the adoption of digital tools will only strengthen our ability to meet the needs of families.
- Collaborative Decision Making. I genuinely believe that cross-collaborative interventions with organizations and individuals that are not often viewed in the same scope are crucial for finding innovative ways to solve problems. For child welfare, this means we must meaningfully engage families and authentically include them in the decision-making process. This begins at the onset with the creation of new child welfare policies or amending existing policies. Parents who have navigated the child welfare system should be viewed as experts to assist in centering child welfare policy decisions that lessen the negative impact on the individual, the family, and the community. This framework will reduce damage centered policymaking and shift the ways in which we serve families.
Our nation’s well-being is dependent on all residents having equal access to safe and supportive environments. Maximizing the opportunities to use innovative approaches that culturally meet the needs of a population is essential to prevention. It also limits the environmental exposures that increase risk and establish building blocks for the healthy development of young people.
Technology, coupled with innovation, can equip social workers with a 21st-century toolbox that is adaptable to the clients and communities we serve. This should be guided by our professional Code of Ethics' preamble, “…to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (National Association of Social Workers, 2017).
This global pandemic provides a critical juncture for the social work profession to reimagine the profession and consider the manner in which we deliver services. What will you be adding to your toolbox?
References
Children’s Bureau. (2018a). Child Maltreatment 2018. https://www.acf.hhs.gov/cb/research-data-technology
Children’s Bureau. (2018b). The AFCARS Report. Adoption & Foster Care Statistics. https://www.acf.hhs.gov/cb
National Association of Social Workers. (2017). Preamble to the code of ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
Mónica Gutiérrez, MSW, a first-generation college student, is in the doctoral program in the School of Social Work at Arizona State University (ASU). She is a Doctoral Fellow in the Robert Wood Johnson Foundation Health Policy Research Scholar Program and a Senior Research Specialist with the Office of Evaluation and Partner Contracts at the Southwest Interdisciplinary Research Center. Her research focuses on structural and institutional racism and how this affects the inequitable distribution of power, land, and other resources for racial and ethnic minorities. She is particularly interested in the use of community-based participatory research to inform social policy, urban planning, and systems change.