Safety net for NC children at risk of abuse and neglect is in need of repair

Over 100,000 North Carolina children wake up to violence, substance abuse and neglect every day, often because their parents are struggling to meet basic needs.

Those who catch the attention of Child Protective Services find a system also in crisis, with too little staff to provide urgently needed services and not enough foster homes where they can stay temporarily or permanently, state officials and advocates say.

The N.C. Department of Health and Human Services reports that, so far this year, an average of 16 children a week stay overnight in a Department of Social Services office because there is nowhere else for them to go.

Last year, it was an average of 32 children a week, according to NCDHHS spokeswoman Kandice Scarberry.

Others are staying in emergency rooms and psychiatric centers, because the state doesn’t have enough foster care homes. It’s even harder to place children with special needs, advocates said.

The foster home shortage has multiple causes, including too few child welfare staff to support the families that take on what can be challenging work, The News & Observer has reported.

Staffing has reached a crisis after several years of retirements, resignations and vacancies in county child welfare offices. The average turnover rate was over 30% in 2023, according to an internal letter from Peter West, section chief for N.C. Department of Social Services county operations.

Some counties were seeing turnover rates as high as 50% or more, compared with a national turnover rate of 14% to 22%, state and federal reports noted.

Child welfare jobs can be challenging and emotionally draining, leading to burnout, secondary trauma and job dissatisfaction, state and federal reports said. Staff members work with limited resources and face a public perception that they are trying to take children from their families, West said.

“I still struggle with people who know I’ve been at this work for 25-plus years in child welfare. They kind of look at you like you are trying to break families apart,” West said. “Our job is to do everything we can to keep children safe and families together, while we help them get to the other side of whatever they’re going through.”

Child welfare workers: Understaffed and overwhelmed

A state study released earlier this year found that most child welfare workers feel overwhelmed, despite having caseloads that largely meet state guidelines.

Intake workers, who review reports and decide next steps, are supposed to handle up to 100 reports a month. Assessment and in-home services workers, who work directly with families, have a standard caseload of up to 10 families.

The statewide average in December 2022 was 45 intake reports per employee, and eight to 12 cases for each assessment and in-home services employee. But some counties, such as Orange County, reported more than 100 intake reports per worker. Several counties also reported in-home and assessment services caseloads that were two to four times the state standard.

Foster care workers in some counties were handling a few dozen cases at once, despite a 15-case state standard, because a family can have multiple children with multiple outcomes.

The staffing crisis worsened during the pandemic and has not recovered, West told The N&O in an interview. Child welfare workers are also handling more intense needs involving drug abuse, domestic violence and mental health problems, he said.

A big challenge for many states, including North Carolina, is that the systems that record information about abuse and neglect cases are often inadequate, said Emily Putnam-Hornstein, a UNC-Chapel Hill School of Social Work professor and lead investigator for the national Lives Cut Short project.

Workers must click through multiple screens to find relevant history when investigating a case or make judgment calls about which boxes to mark on an extensive checklist of potential risks a child faces, with limited time to do so, she said.

“In child welfare, we ask workers to not just be responsible for those immediate safety decisions, but we also hold them responsible for future risk of harm,” she said. “And what human beings are not very good at is assembling lots of information and figuring out which of those children is the most likely to be harmed in the future.”

A system in need of restructuring

A further complication in North Carolina is structural, and an overhaul is in the works, state officials say.

North Carolina uses a state-supervised and county-administered social services system — one of only nine such systems in the country, NCDHHS officials said.

While the system gives county child welfare agencies flexibility to address local challenges and work with regional partners, it also leads to inconsistent training and reporting, inadequate data and children being left in unsafe situations.

A 2019 legislative report found that county DSS offices did not provide services to families in over a third of the allegations reported statewide. But the percentage varied widely, from 12% of reports being screened out in some counties to as much as 60% in others.

Some child deaths are not preventable, Putnam-Hornstein acknowledged. But what’s really hard is when a child fatality review detects human errors or missing information that could have helped avoid a tragedy, she said.

“It’s heartbreaking, because you realize that had we assembled all of that in real time, we probably would have made a decision that would have protected that child, but we missed it,” she said.

Kella Hatcher, executive director of the N.C. Child Fatality Task Force, said the state’s child fatality prevention system is also “disjointed.”

“We’ve been told by national experts that we have one of the most complicated systems in the country. Not the best or the worst — we do a lot of good work — but it’s complicated,” she said.

Each county has two child fatality review teams — one for children involved with Social Services and one for other child deaths. Both report to the State Child Fatality Prevention Team, which also reviews deaths, and the N.C. Child Fatality Task Force, which recommends policy changes.

Each group is headed by a different state office.

The state is creating a State Office of Child Fatality Prevention this year and hiring regional DSS directors to help implement consistent policies and recordkeeping. By 2025, citizen child fatality review panels could be appointed, and the local review teams replaced by single teams covering one or more counties.

Those and other changes stem from Rylan’s Law, a set of child welfare and social services program reforms approved by the state legislature in 2017. In 2019, the state DHHS followed up with an extensive, third-party study of the state’s staffing crisis and possible solutions.

In 2020, the state began reporting abuse and neglect cases that did not trigger an investigation or in-home services to the federal database. The move paints a more accurate picture of what’s happening and could connect more families with services, Scarberry said.

To report child abuse or neglect

North Carolina law requires all adults to report suspected cases of child abuse or neglect. Cases can be reported to 911, or your local Social Services office or Health Department. The National Child Abuse Hotline is also available at 800-4-A-CHILD (800-422-4453).