Moral Distress Among Child Welfare Social Workers- the Role of Internal and External Constraints

Background and Purpose: Examined predominantly in nursing, moral distress refers to painful feelings and/or psychological uncertainties that occur when one is aware of the morally appropriate action to take but is unable to take that action because of internal (e.g. fear) or external constraints (e.g. lack of time or resources; Corley, 2002; Jameston, 1984; McCarthy & Deady 2008). Research suggests that moral distress is potentially faced by many child welfare social workers (CWSW) who hold the dual role of helper and social control agent (Sugrue, 2019). Child welfare work also occurs within the context of systemic injustices (e.g. abject poverty, institutional racism, community trauma) and a resource-strained system (e.g. lack of resources for families, high caseloads, turnover), all of which potentially constrain CWSW’s ability to do what is needed to advocate for and best serve families. These constraints place CWSW in ethically compromising situations, contributing to experiences of moral distress that impact their well-being and retention (Sugrue, 2019). Using a sample of CWSW, this study aims to: 1) explore the phenomenon of moral distress, as measured by Parker’s organizational climate role conflict subscale (i.e. “I have to do things on my job that are against my better judgment”; Gagnon et al., 2009); 2) examine the relationship between internal (i.e. psychological safety) and external constraints (i.e. job stress, time pressure) and moral distress.

Methods: Workforce data comes from two state and two county public child welfare agencies. An organizational health assessment was sent to 5,787 staff members and was completed by 4,117 participants (71% response rate). This study utilizes a subsample of caseworkers and supervisors with BSW and/or MSW degrees (N=787). Moral distress is measured using the role conflict subscale (4-items) in Parker’s Organizational Climate scale. Internal constraint is measured using the Edmundson Psychological Safety scale; external constraints are measured using time pressure and job stress scales (both 5-items). Linear regression examines the relationship between internal and external constraints and moral distress, while controlling for secondary traumatic stress, burnout, and demographics characteristics.

Results: One-third of CWSW indicated that they have experiences of moral distress as measured by role conflict. The overall regression model was statistically significant, F(11,632)=19.65, with an R² of .25 (p<.001). Parameter estimates indicated that psychological safety was negatively related to moral distress (b=-.38, p<.001), while time pressure (b=.09, p<.05) and job stress (b=.14, p<.05) were positively related to moral distress.

Conclusion/Implications: Results indicate that CWSW’s experience morally distressing situations in their work and that both internal and external constraints potentially heighten experiences of moral distress. For CWSW whose profession centers around the protection of children and strengthening families and who are also held to social workers’ code of ethics, experiences of moral distress may impact client outcomes (e.g. delivery of services), worker well-being, and retention. Suggestions for future moral distress research in child welfare, its impact on worker well-being, and strategies to promote retention in the profession will be discussed.