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The number of front-line child abuse staffers at Iowa’s Department of Human Services has declined in the past 15 years, caseloads have risen and state funding has failed to keep pace with inflation, a Des Moines Register review of state data shows.

With state resources unlikely to improve in the wake of continued budget shortfalls, questions are being raised about whether the agency tasked with attending to Iowa's neediest children can keep pace with increased demands for vigilance following the deaths of two teenage girls.

The department reported an increase in calls to its child abuse hotline following the deaths of two Iowa teenagers, Sabrina Ray and Natalie Finn. Despite involvement from state workers, both girls were found dead in their homes — the result of apparent abuse and neglect, allegedly at the hands of their adoptive families.

The two cases, which bear disturbingly similar details, raised alarm bells among the public, lawmakers and others who questioned whether overburdened social workers missed potential warning signs.

State social workers divide their attention between dozens of cases and often burn out after just a short time, said Jean Muhammad, 42, of Ames, who previously worked in child protective services for the state.

"There was a saying at the department: 'Off probation, on medication,'" Muhammad said, referencing the probationary training period before social workers begin taking on their own cases.

"Which means that a lot of social workers are taking medication so that they can sleep or to cope with things like anxiety and depression or other stress-related health problems," she said.

Agency Director Jerry Foxhoven acknowledges the department has not done enough to ease the anxiety and stress of its social workers, which has helped fuel widespread issues with morale. But he contends current staffing is adequate.

"I’m committed to creating the best safety we can for kids," said Foxhoven who was appointed in June with a mandate from Gov. Kim Reynolds to protect children and stabilize a department that has faced criticism from all sides over its handling of child welfare cases.

"I’m convinced we can do it with (the resources we have) right now, that we can do that effectively," he said in an interview with the Des Moines Register. "... If you cut below a certain level, you can’t do it anymore. Right now, we can do it."

If cuts ever came in at a level that began to threaten child safety, Foxhoven said, "I wouldn't stay in this job, and that's the truth. But I don't think that's what's going to happen."

Staffing

The Department of Human Services employs more people than any other state agency, with the exception of the state universities.

In 2017, it had 4,395 full-time equivalent positions, according to the Legislative Services Agency.

That's down by about 17 percent — or 908 people — since 2002. Foxhoven said much of the overall decline is the result of closing state-run institutions, like the mental health institutes in Clarinda and Mount Pleasant.

But the number of front-line people handling child welfare cases for the department also has fallen by about 15 percent during that same time frame.

In 2002, 653 people were classified as a “Social Worker 2” or “Social Worker 3.” By 2017, that number had dropped to 557. Both classifications of employees work in the field to assist families and neglected and delinquent children, but a Social Worker 3 has a higher level of education and training and is responsible for investigating allegations of child abuse.

The number of Social Worker 3s rose during that time by about 6 percent, but the number of Social Worker 2s fell by nearly a quarter.

Caseloads

As staff declined, caseloads went up, particularly for Social Worker 2s, like Muhammad.

In 2002, those workers handled an average of 91 cases per person. By 2017, the average had increased nearly 20 percent to 109 cases.

Muhammad said it becomes harder to manage every aspect of a case as caseloads increase.

"I can’t tell you how much time it takes," she said of each case she worked. "You are, first of all, assuring the child’s safety by doing monthly home checks. You're communicating with their school, their therapist, their foster care provider or relative placement, making sure they are having all their medical and dental needs met by confirming appointments, following up on doctor recommendations. Also sometimes ensuring transportation to and from therapy appointments, making referrals for behavioral health services, ensuring visitation is happening if it’s ordered, which it usually is, making sure sibling contact is happening.

"And that’s just the kids."

For Social Worker 3s, caseloads ticked up slightly from 11 cases in 2002 to 12 in 2017.

Those numbers come from the Department of Human Services, which calculates caseload by taking its total number of cases and dividing by the number of workers in that classification.

But many, including Muhammad, suspect that method likely understates just how many cases social workers are handling at any given time.

It often takes about eight months for new employees to build up to a full caseload, Muhammad said. That means senior employees regularly handle more than the average caseload as newer employees undergo training. And when turnover is high, like it is now, there are always new employees, she said.

Some of Iowa's reported caseloads are significantly higher than the standards laid out by national organizations. The Child Welfare League recommends that workers providing ongoing child protective services serve no more than 17 active families.

However, that’s not an apples-to-apples comparison with the way Iowa calculates its caseloads, Foxhoven said.

Iowa has a contract with private companies to provide what it calls Family Safety, Risk and Permanency services. Those workers coordinate with Iowa's social workers and do many of the in-home visits people associate with social work. Even so, he said he wishes caseloads were smaller.

"Of course I am concerned about it," Foxhoven said. " ... Would I like the caseloads to be lower? Yeah," he said. But with the Family Safety, Risk and Permanency contract, "it wouldn’t make sense to have them as low as the national standards are."

Instead, he said, he's focused on taking "bureaucratic" things off the plates of his social workers, allowing them more time to focus on kids and families. He's also meeting with them individually and in groups to learn what they need and want from the department.

Social workers in Polk County, he said, didn't even have work-provided cell phones to communicate or access Internet-driven resources from the field. They were constantly going back and forth to the office, he said.

"Little stuff like that makes a big difference not only in their morale but in helping them to get their work done," Foxhoven said.

Muhammad left the department after about 18 months when it became too difficult to balance frequent evening and overtime work with her family obligations, she said.

"I just became convinced that the sacrifices that I was making just were not worth the sacrifice of my family and the role in my family," she said.

Her 18-month stay was longer than that of many of her colleagues who began at the same time, she said.

Funding

The state closed out the 2017 budget year with a $14.6 million shortfall — even after lawmakers approved nearly $250 million in cuts and reserve fund transfers in an effort to balance the budget. They've already downgraded their revenue estimates for the current budget year, possibly setting the stage for continued cuts.

The Department of Human Services has shouldered $124.2 million in cuts since 2016.

Foxhoven said he's looking for every possible way to make cuts within the department that don't affect child welfare services.

"We have literally made the decision on the grounds in Cherokee to let more of the grounds go to prairie instead of mowing it," he said, referencing the state's mental health institute there. "I mean, we’re literally doing that to be able to say we don’t want to lose child protection workers or child welfare workers."

In another cost-saving measure, the department has stopped sending paper notices that adoption subsidies have been directly deposited into recipients' bank accounts.

"If you think about it, for 9,000 letters going out every month, just the postage alone is somebody’s job," Foxhoven said.

Since 2006, state funding to programs directly linked with child welfare has increased by about 7 percent, compared to a 22 percent increase in consumer prices in that period, according to federal data.

Those areas of the the state's general fund budget include child abuse prevention, field operations, adoption subsidies, and child and family services. The total spent in 2006 on those programs was $164.5 million. It peaked at $192 million in 2009 and now has fallen to $175.3 million in the 2018 budget year.

Sen. Matt McCoy, a Democrat from Des Moines who has been vocal in calling for reform of DHS, said he was especially concerned about cuts made to the department last year that resulted in the loss of matching federal dollars.

He said he's not particularly hopeful that the Legislature will increase funding to the department, given its current budget situation.

"I’m getting to the point now where I’m just continually shocked that people are not tearing clothes over this issue," he said. "I continue to think that every time something bad comes out or every time another child is tortured or abused or beaten that that’s going to be the straw that breaks the camel’s back. But I’m not convinced that (legislators) understand or grasp how many vulnerable Iowans are impacted right now."

Asked at a press conference last month whether the department needs more funding to address child abuse issues, Gov. Reynolds spoke about the importance of living within a budget.

"It’s not always … additional money," she said. "We have to live within our budget. But there’s a lot of things that can be done within the existing structure, I think, that can make a difference also."

DHS staff, by the numbers

Social Worker 2

2002: 456

2017: 349

Percent change: -23.5 percent

Social Worker 3

2002: 197

2017: 208

Percent change: +5.6 percent

Total social workers

2002: 653

2017: 557

Percent change: -14.7 percent

*Numbers are filled, full-time positions in January of each year

DHS caseloads, by the numbers

Social Worker 2

2002: 91 (Child welfare cases only: 24)

2017: 108.7 (Child welfare cases only: 30)

Percent change: +19.4 percent

Social Worker 3

2002: 11

2017: 12

Percent change: +9 percent

**The "child welfare cases" number includes only traditional child welfare cases that require a monthly visit by the case manager. The "all workload" cases include responsibilities such as day care spot checks, adoption subsidy cases, licensing and some adult cases.