Child Welfare Caseworkers' Perceptions of Responsibility for the Behavioral and Emotional Needs of the Children in Their Care

Purpose

Children in the child welfare system have complex mental health needs and the role of child protective service workers has shifted from caseworker to behavioral health care manager. However, little is known about the extent to which caseworkers perceive behavioral health care management as a part of their professional responsibilities, which is of concern given the high rates of mental health needs among children in protective custody. To address this gap in our knowledge, we analyzed nationally representative survey data about child protective service workers’ perceptions of responsibility for the management of mental health services for the children in their care.

Methods

We used data from the 2009-2010 National Survey of Child and Adolescent Well-Being (NSCAW) to examine the perceptions of 2,827 child protective service workers regarding their responsibility for the management of mental health services for the children on their caseloads. Caseworkers answered five questions about activities related to the care of children receiving mental health services (e.g., Are you responsible for arranging for evaluation or treatment appointments?). Each item had the following response pattern: (1) not at all responsible; (2) somewhat responsible; or (3) very responsible. Then, we created a variable to identify caseworkers who perceived they were very responsible on any of the five items regarding children with mental health needs.   

Results

Among the 2,827 respondents, 56% (n=1,583) were white, 83% (n=2,346) were female, and 51% (n=1,442) had a bachelor’s degree. Only 28% (n=792) of caseworkers reported they felt very responsible for arranging evaluation or treatment appointments for children on their caseloads who had mental health needs, whereas almost 30% (n=820) reported they perceived no responsibility at all. Only 34% (n=961) of caseworkers perceived they were very responsible for reporting medication at team meetings and 44% (n=1,244) perceived they were very responsible for obtaining permission from biological parents or the courts for medication use.

Also, just over half (52%, n=1,470) of caseworkers perceived they were very responsible for reporting on medication use at court hearings and 58% (n=1,640) reported they were very responsible for documenting medication use in their records. In total, one third (33%, n=933) of the caseworkers in the sample reported they felt very responsible for the management of care for the children on their caseloads with mental health needs (i.e., answered “very responsible” for any one of the five items).    

Implications

The extent to which caseworkers have been asked to serve as care managers of mental health services for children in their care who have complex mental health needs has increased considerably over the last few years. Our findings suggest that caseworkers’ perceptions of their professional responsibility to advocate for and manage the mental health care and service needs of the children on their caseloads vary considerably. Given the complex mental health needs among children in protective services, ongoing education, training and support is needed to help protective service workers  meet the increasing demands to serve as care managers for the children on their caseloads who have mental health needs.