Performance-Based Contracting, Caseworker Role Overload, and Service Provision in Child Welfare

Background and Purpose: Although performance-based contracts have become increasingly popular in child welfare, administrators are developing these contracts with little empirically guided information about how internal work conditions may influence the services families actually receive. This study examines how child welfare caseworker role overload moderates associations between agency use of performance-based contracting and the services provided to families

Methods: Data were drawn from 622 permanent caregivers and their caseworkers within 54 child welfare agencies that participated in the National Survey of Child and Adolescent Well-Being (NSCAW). Negative binomial, Poisson, and logistic regression models were used to examine the relationship between child welfare agency use of performance-based contracting and the services provided to families involved with child welfare given high versus low caseworker role overload. Services were measured as caseworker time devoted to case management; caseworker time providing in-home services to families; the number of social services received by permanent caregivers; and permanent caregivers' receipt of necessary mental health services or substance abuse treatment. Final sample sizes ranged from 515-557 in models run for all permanent caregivers, and from 143-239 in models restricted based on caregiver need for behavioral health care.

Results: The combination of performance-based contracting and high caseworker role overload was negatively associated with caseworker hours spent on case management and referrals (IRR 0.65, p<0.05), hours of in-home service provision (IRR 0.48, p<0.01), and the number of social services received by permanent caregivers (IRR 0.62, p<0.01). In contrast, the combination of performance-based contracting and low caseworker role overload was positively associated with caseworker hours spent on case management and referrals (IRR 1.43, p<0.05) but negatively associated with caseworker hours spent on in-home service provision for families (IRR 0.69, p<0.05) and with permanent caregivers' odds of receiving mental health services (OR 0.07, p<0.05).

Conclusions and Implications: Findings suggest that use of performance-based contracts may sometimes lead to less intensive child welfare agency case management for permanent caregivers. When caseworkers experience high role overload, use of performance-based contracts may also decrease caregivers' likelihood of receiving other necessary social and behavioral health services. Policy makers and child welfare agency directors considering the use of performance-based contracts may wish to consider how existing factors within the child welfare agency may distort incentive structures and negatively influence desired case management processes for permanent caregivers.