Exploring Policy Implications of Ethics of Care and Justice in Care Work and Human Services Organizations

Abstract

Much attention has recently been focused on the efficacy of cross-sector collaboration within the field of human services in response to increasing rates of child maltreatment and subsequent foster care entries nationwide. Our research includes 200 hours of participant observation, in-depth, semi-structured interviews with 65 professionals broadly involved in the protection of vulnerable children and the support of their parents, and an analysis of 45 case files. It was carried out in a rural region of Kentucky between May 2015 and July 2017. We used established principles of analytic induction to analyze our data. In this study, we explore perceptions of power, authority, inequality, and bureaucratic constraints that emerge during organizational processes of interagency collaboration among multidisciplinary human service organizations situated within the child welfare system. We argue that ethics of care and, subsequently, care work are constrained by power dynamics, primarily embedded in bureaucratically structured human service organizations as well as in policy mandates that embody ethics of justice. We conclude that the tensions between bureaucratic constraints and professional workers’ desire to care for and serve clients often disrupt and undermine organizational missions and policy goals targeting child protection. We indicate the need to examine these structural dynamics at a policy level and provide recommendations with policy implications.

Keywords

bureaucracy power human services collaboration child welfare ethics care work social policy

Introduction

Care work, such as social work, nursing, and home health care, among other jobs, is challenging emotional labor with critical social policy implications. Care workers often sacrifice much in their personal lives to provide for the needs of others. Such professional labor is provided through bureaucratic institutions that are mandated by policy to meet legal and budgetary requirements. Care workers often go into their professions with a desire to help others and an inadequate understanding of the ways their labors may be made difficult by bureaucratic and rationalized policy mandates. In this paper, we draw upon an analysis of 45 case files, 200 hours of participant observation, and 65 in-depth, semi-structured interviews with professionals involved in protecting vulnerable children from abuse and neglect and providing families with support as they endeavor to improve their situations and parenting skills. Our aim is to explicate the ways in which systems of child protection as a form of crisis-oriented human services is steeped in gendered ethical assumptions that often impedes the care work dedicated professionals strive to provide.

Drawing upon the foundational literature of Carol Gilligan (1982), Nel Noddings (1984), Dorothy Smith (1987), and similar feminist scholars whose bodies of work provide a framework for understanding the gendered nature of relational caring, ethical decision making, and dominant ideological discourses (Smith 2017), we analyze the differences between the ethical intentions of care workers and the legal and budgetary mandates of a rationalized system of child protective organizations which are grounded in an ethic of justice. Gilligan (1982) and Noddings (1984) found that women and men tend to make moral decisions based on different ethical standards. While both scholars maintain that these differences are not innate, Gilligan shows that women tend to approach decisions based on an “ethic of care” in which they consider the relational dimensions of problems along with the motivations people have for their actions. By contrast, men tend to rely upon an “ethic of justice,” which entails considering the law, policy, or rules and judging actions by the letter of the law. These ethics are similar, but not identical to Noddings’s (1984) argument that men tend to focus on “principled policies” that promote compliance, whereas women’s ways of knowing and understanding the world are based on ideals of receptivity, relationships, and reciprocity.

Our work expands upon these microlevel explanations and extends them to bureaucratic and formally rationalized systems at both the meso and macro levels of sociological analysis. Building further upon Smith (1987), we explore the ways in which “texts,” in addition to other forms of institutional discourse, such as policies, training, and cross-sector engagement through interagency collaboration, enact hegemonic discourses about gendered relations and gendered power in social work and related human services professions (Reskin 1993; Smith 2017). Our goal is to highlight institutionalized gender dynamics and open a policy-oriented discussion about conflicts between organizations and those who work to reduce child maltreatment. Our study provides a critical gender analysis of the rationalized bureaucratic structures in which care workers endeavor to protect children and support parents.

Scope of the Problem

Child abuse and neglect constitute a serious social problem and a public health issue (Finkelhor 1991). In 2018, approximately 7.8 million children were referred to state child protective services (CPS), and nearly 58.5 percent of those children were screened in to receive a CPS investigation or alternative CPS response (Childhelp 2019; US Department of Health and Human Services 2019). Federal data show the number of children who received a CPS investigation increased by from 17.7 children per 1,000 in the population in 2014 to 23.5 as of 2018. The rate for first-time child victims similarly increased from 12.4 in 2014 to 15.7 in 2018. In 2018, approximately 678,000 child victims experienced at least one substantiated or indicated incident of maltreatment nationwide, and some 1,770 children died during the federal reporting period as a result of child abuse and neglect. Nearly 80.3 percent of child maltreatment fatalities involved at least one parent as the perpetrator. Financial costs associated with child maltreatment including foster care and other services run as high as $124 billion annually (Childhelp 2019).

From a sociological perspective, family violence including child maltreatment is symptomatic of deeper structural constructions of power, privilege, and inequality (Miller and Knudsen 2007; Straus, Gelles, and Steinmetz [1980] 2006; Wallace 2002). Societal reactions to family violence have been inconsistent and contingent upon historical norms, ideals, trends, and cultural shifts; however, an increasingly formalized, bureaucratically structured organizational response to family dysfunction and violence has taken shape since the 1960s (Winton and Mara 2000). While necessary and beneficial in many regards, such rationalization is complicit in further institutionalizing inequalities that affect the potential for family violence and child maltreatment.

Child maltreatment

Since the 1960s, child maltreatment has consistently gained societal attention and become a focus of social research and intense policy development (Horner 2008). Child maltreatment is defined by federal legislation as

Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm. (H.R. 867 1997)

It is a multidimensional, complex social problem that requires multisystemic and collaborative organizational responses (Crossen-Tower 2002; Winton and Mara 2000). Interagency involvement across institutional domains necessitates the capacity for effective communication, relationship building, and collaboration at local, state, and federal levels (Butler et al. 1995; Horwath and Morrison 2007; Langhout and Thomas 2010).

Literature Review

Human service organizations are structured within institutionalized systems of care (ACT Government 2016; Hasenfeld 2013; Mayhew 2012) and are integrated in labyrinthine ways designed to meet a complex range of individual and family needs (Hood 2014). Institutionalized systems of care function to stabilize and meet some of society’s most basic needs, including strengthening families and protecting children. Thus, the human services field comprises a dynamically integrated conglomerate of complex organizations with a vast complement of institutional missions, goals, and targeted policy outcomes. Although steeped in complexity, consistent attributes of human service organizations continue to be recognized, including the premise that human services are moral, ethical, and caring practices established by law and social policy.

Ethics of Care and Justice

Human services evolved out of and were founded upon moral principles and professional ethics rooted within broader institutionalized systems of care (Clark 2006; Hasenfeld 2013; O’Brien 2005). Yet, the more bureaucratized human service organizations become, the more these rationalized systems collide with mandates to care for families and children (Hugman 2014; Hood 2014). Specifically, the caring work of human services, steeped in an ethics of care, often conflicts with the bureaucratic dictates of a formally rationalized system, steeped in an ethic of justice (Acker 1992, 2012). Thus, policy and practice easily become misaligned. Ethics of justice tend to focus on rules and procedures, whereas ethics of care are focused on how decisions will affect relationships (Gilligan 1982). Similarly, Noddings (1984) asserts that principled policies, based in a detached masculine ethics of justice, promote compliance whereas caring relationships, based in a more responsive and relational feminine ethics of care, promote connection and reciprocity. To be clear, we are using these micro-oriented theories to explicate the dynamics of power institutionalized in highly rationalized systems of care. Below we demonstrate the clash between professionals’ desire to exercise ethics of care and the way the systemic ethics of justice impedes their work.

Previous scholars have emphasized the need to implement ethics of care in work practices, including engaging in interagency collaboration as a best practice approach within human services (Gilligan 1982; Hugman 2014; Moore 2016; Sowa 2008). Although interagency collaboration as an intrinsic form of cross-sector collaboration is an engagement strategy for integrating multidisciplinary human services, this approach has also been viewed as conflicting with rationalized modes of efficient and productive organizational work (Almog-Bar and Schmid 2018; Brudney et al. 2018; McAllister and Dudau 2006). A consistent problem is the interface of masculinized and bureaucratic organizational standards with the traditionally feminized tasks of care work.

Organizations are characterized by an ideal type of hierarchal bureaucracy (Acker 2004; Britton 2000; Kanter 2008). Within this framework, ethics of care are inherently constrained by rationalized policies, practices, and interactions, or an ethic of justice (Acker 2012; Britton 2000). Traditionally, bureaucratic forms of organizations rely upon a managerial hierarchy and a coercive implementation of formal rules, plans, and procedures. While such formalities are viewed as necessary for consistency, order, and organizational stability, they deter more participative forms of coordination, consensus-building, personal connectedness and relationships, professional empowerment, and sharing of power and leadership, or what we conceptualize as a model based on an ethic of care.

Limitations in organizational flexibility and adaptation may drastically inhibit the motivation and ability of human service organizations to participate in interagency collaboration, a “best practices” model designed to foster cooperative work among the various actors, organizations, and government agencies and entities charged with addressing child abuse and neglect (Berry 1997; Campbell et al. 2019; Fraser and Pecora 1991; Whittaker 1990). Interagency collaboration has been defined as “any joint activity by two or more agencies working together that is intended to increase public value by their working together rather than separately” (Bardach 1998) and is both a process for institutional cooperation and an arrangement among institutions (Gray 1989; Rivard et al. 1999). Collaboration provides opportunities for different agencies to contribute varied perspectives of a problem or an issue and can be a powerful tool for assisting recipient families who are served by an integrated community of organizational providers.

Ethics of care within human service organizations reflect the institutionalized norms, values, beliefs, and processes of its constituent agencies. Therefore, interagency collaboration as an ethical practice of care is a process of intraprofessional, interprofessional, and interpersonal social interaction (Rivard, Johnsen, Morrissey, and Starrett, 1999: Coleman and Rippin 2000; Ely and Meyerson 2000). Much research has shown that effective collaboration among interagency partners may be the best method for enhancing the prevention of child maltreatment as well as decreasing intimate partner violence and other threats to family safety and well-being (Darlington, Feeney, and Rixon 2005; Johnson and Cahn 2005; Sowa 2008).

Collaborative practices are counter to hierarchical bureaucratic work modes in many important ways (McAllister and Dudau 2006). First, collaboration calls for sharing of tasks and ideas about how work should be organized, whereas bureaucracy relies upon an ordered division of labor and specialized functions. Second, it may have a flexible leadership structure which conflicts with a bureaucratic administrative hierarchy. Third, collaboration lends shared accountability to participants while bureaucracy mandates stricter managerial responsibility.

State-operated organizations, such as the courts and CPS, are tasked with immense responsibility for the safety, well-being, and permanency of children as well as the general welfare of individuals and families. In the current study, CPS was charged with working collaboratively with police, attorneys, psychologists, physicians, and a wide variety of nonprofit organizations, under the court-ordered mandate of judges. Our paper examines the axis of power, conceptualized as an ethic of care versus an ethic of justice, that affects interagency collaboration among a wide array of entities, organizations, and government agencies charged with intervening in alleged cases of child abuse or neglect and preventing future abuse. Our research examines the ways in which government mandates and bureaucratic requirements concurrently compel and constrain collaboration and the effective delivery of services to families in crisis.

Data and Methods

Data for this study come from ethnographic research conducted in a multicounty human services region located in a rural district of Kentucky between May 15, 2014, and June 30, 2016. To add context, the geographic region consisted of largely outlying agricultural communities surrounding one to two smaller towns to mid-sized cities within each county in an area with access to one urban, more densely populated city. Our research focused on how the care workers who served the families living in these communities perceived, defined, and enacted professional care work and the ways their work was facilitated and constrained by rationalized mandates. The first author gathered all data. The second author managed the project.

The first author had two decades’ experience working as a human services practitioner and researcher at both the regional and state levels and was well-known and trusted throughout the region. Drawing upon professional contacts within a multicounty in-home crisis services program which served as a gateway agency, she was able to gain entrée to the community of human service organizations and their employees, which are the focus of this study. The partner program was selected as a viable gateway agency because of its mission and model of care work, which included an obligation to engage in interagency collaborations with myriad other human service organizations in order to stabilize crisis-affected families and prevent the reoccurrence of substantiated child maltreatment (Berry 1997; Fraser and Pecora 1991; Whittaker 1990).

The sample population consisted of key informants who were agency representatives from human service organizations who regularly collaborated with representatives from the partner agency. Sample participants were recruited using a purposive convenience sampling method of chain referrals, or snowball sampling (Charmaz 2003, 2014). Snowball sampling was the most appropriate method due to the confidential nature of human services and the need to be conscientious about privacy within a community of organizations who shared a client population. The professionals who participated were representative of a broad cross-section of organizational concentrations including CPS, law enforcement, the judicial system including judges and attorneys, mental health providers, the medical community, victim advocacy staff, school-based family care workers, a domestic violence shelter, a homeless shelter, foster care and independent living coordinators, military family case workers, and a selection of care workers from specialized human service organizations. An essential criterion for the sample population was the regular and preferably recent (within the calendar year preceding the timeline for the study) collaborative involvement with the partner agency. While we tried to involve at least one woman and one man from each organizational affiliation type, for many organizations only one participant was available. Participants lacked racial diversity and consisted of nearly 87 percent Caucasian care workers; however, the demographics of the sample closely aligned with those of the population in the region we studied, which was approximately 83.2 percent Caucasian (US Census Bureau 2019).

Qualitative methods were selected as the best means for attaining rich, descriptive data about the collaborative experiences of key respondents from each of the different organizational affiliations or disciplines. The use of qualitative methods often provides a theoretical depth and richness of clarification that is difficult to attain from other methods (Charmaz 2014). We used focus group interviewing, participant observation, and in-depth interviewing to collect data. The use of multiple qualitative methods, or “triangulation,” has been recommended by previous social scientists as a means of convergent validation (Berg and Lune 2012). The use of multiple qualitative methods helped to counter the imposed perspective a single method may place on the social reality of a particular social setting or sample population.

The first author completed approximately 200 hours of participant observation between May 2014 and June 2016 during which time she witnessed diverse opportunities for interagency collaboration including staff meetings and case consultations, staff workroom interactions, file maintenance and case file review procedures, supervisory meetings, corporate administration visits and meetings, home visits with family recipients, partner meetings and office visits, communication modes and strategies (e.g., telephone, e-mails, text messages), reporting and outcome tracking, and hiring and training of new and existing staff. She took jottings while in the field and recorded full field notes immediately upon exiting, a procedure recommended for researchers working in a familiar social setting (DeWalt and DeWalt 2011). Field notes were hand-coded prior to consolidating categories of meaning through memo writing (Charmaz 2014; Miles and Huberman 2013). Two focus group interviews with 22 total participants were held with employees from the gateway agency during the time allocated for regular staff meetings. The first focus group interview took place in July 2015 and the second occurred in November 2015 at the request of staff unable to attend the first group. The combined focus group interview time was approximately 4.25 hours. Focus group questions included topics such as positive and negative collaborative experiences, and participants were asked to discuss their perceptions of power and authority exerted by, between, and among a range of local human services organizations. Each group was audio recorded and later transcribed verbatim. The use of focus groups allowed participants to raise issues of importance to them, some of which had not been identified in the literature (Barbour 2008) Focus groups and participant observation helped to facilitate our aim to have our research represent the “standpoints” of those engaged in this service work (Smith 1987).

The first author conducted in-depth, audio-recorded, semi-structured interviews with 50 professionals from 30 localized human service organizations. The interviews were transcribed verbatim. In-depth interviews are a method that allows a research subject to speak openly and confidentially about topics that may be private or controversial and creates an atmosphere that allows for a greater depth and range of understanding than might be achieved through other methods (Gillham 2000). The interviews ranged in length from 29 minutes to an hour and 45 minutes with an average duration of 70 minutes. Interview questions asked participants to describe positive and negative collaborative experiences and their perceptions of motivations, strengths, and barriers of interagency collaboration. Some of the organizations operated specialized human service programs; thus, the sample included representatives from 47 specifically targeted human service programs. Inclusion criteria involved recent collaborations with the gateway agency, a multicounty in-home crisis services program, as well as sharing one or more recipient client families with at least two additional local human services organizations or programs. The organizations included voluntary and faith-based agencies, local non-profit and for-profit agencies, private businesses, and organizations that were local departments or divisions of state and local government.

Qualitative data analysis involves transitioning from patterns and themes grounded in concrete data to more abstract concepts and emergent theories (Charmaz 2003; Corbin and Strauss 2014). This process requires constantly asking questions and challenging potential answers through constant comparisons. Staged coding was used to determine initial patterns and trends in the data, followed by identifying emergent concepts and theoretical explanations. Concepts and categories were labeled and provisionally identified pending subsequent supporting evidence from the data. At each step, we went back to the data to ensure that our interpretations were reflected in our field notes and transcripts. We used ATLAS-ti (Muhr 1997) to categorically process coding and to generate memos and themes. Once coded, we used analytic induction procedures to refine the theoretical application of existing or new concepts related to interagency collaboration (Charmaz 2014; Gillham 2000). An additional validation strategy the first author incorporated throughout the study was an ongoing collaboration with two professional colleagues, both of whom were licensed social workers with over 10 years of applied clinical experience. This strategy has been recommended on validation of qualitative methods and findings (Hesse-Biber 2010; Miles and Huberman 2013).

The use of qualitative methods allowed us to access a more holistic view of the area of focus according to the perceptions and the lived experiences of the participants (Miles and Huberman 2013; Saldaña 2014). For the purposes of this study, qualitative methods were best suited to developing understandings of processes, such as the exercise of power among groups (Charmaz 2014). Qualitative methods were also used to “bridge” active participants in the research process, an important component of a feminist approach to doing qualitative research (Acker, Barry, and Esseveld 1996). Involving participants in the research process is a critical opportunity to establish rapport, trust, and ongoing communication; therefore, using qualitative methods, such as participant observation, qualitative interviews, and focus groups, fostered a more collaborative mode of conducting social science research.

Findings

Our study identified four predominant themes that emphasize where and how an ethic of care collides with an ethic of justice and bureaucratic rationalization. Specifically, intensive care work conflicts with business aspects of child protection, such as the need to meet production goals (i.e., completing a minimum number of cases and/or a minimum number of direct service hours per case within a specified legal or budgetary timeframe) to remain competitive for funding. These conflicts can contribute to burnout and high turnover among staff. Within human services, professional care workers commonly carry a “case load,” which refers to the number of recipient families or individuals being served by a single employee at any time. Limitations on the number of recipient families or individual clients on a caseload may be specified by state law, contractual mandates, or organizational policies relative to best practice guidelines. Structured and organized case work practices within human services are recognized as necessary for ensuring treatment success, yet the legal mandate to investigate all legitimate allegations of child abuse or neglect within 24 hours often means that workers may need to carry more cases than mandated.

Theme 1: Competing Demands

When allegations of child maltreatment are substantiated (i.e., maltreatment was confirmed and the child(ren) found to be in need of services), professionals are legally required to develop a plan that will do one of three things: keep families together, reunite parents with children after a period during which children are placed in state-sponsored care, or terminate parental rights. Parents must satisfactorily complete recommended or court-ordered programs within a set time frame or risk serious legal consequences such as having their parental rights terminated. Participants in our sample consistently described working caseloads that ran higher than the maximum number of cases allowed per worker as mandated by organizational policy or law, myriad and often duplicative paperwork that was required for every interaction with a family member and related collateral contacts, and pressure to resolve cases that was constant and intense. Workers from almost all the agencies we examined reported lacking sufficient resources needed to do their work effectively and that the paperwork and bureaucratic demands of their jobs impeded efforts to effectively support families. Care workers discussed the ways they internalized these competing demands and the high levels of stress and anxiety that resulted from the pressures of their jobs.

In the majority of cases observed, parents were court-ordered to attend a variety of classes and receive an array of services so that they could keep or regain custody of their children. Courts, judges, police, and prosecuting attorneys were, by law, agents of an ethic of justice, despite the fact that families facing allegations of abuse or neglect had their cases heard in family courts, designed to be more flexible and caring than civil or criminal courts. Caseworkers, meaning those charged with investigating allegations of abuse or neglect and subsequently with assessing needs, coordinating services, and evaluating progress toward court-mandated goals, were constrained by high caseloads and the requirement to document every interaction with parents and children using established forms that had to be filled out and submitted on time. Their desire to help families and protect children was made more difficult by low levels of funding for needed services and by the fact that they were located in a rural area where services that did exist were located over a wide area. Furthermore, the need to complete and submit paperwork in a timely manner stood in competition with meaningful interactions with families. Employees commonly reported feeling overwhelmed by the competing demands and sheer overload of the work they were tasked with accomplishing.

Families’ and children’s needs were urgent and intense. Care workers described high caseloads where families often had competing needs. For example, parents might be court-mandated to attend substance abuse counseling or parenting classes yet lack a vehicle or the income needed to travel to such services. The lived reality of working a caseload, according to the participants in our study, was that it was often frenetic, overwhelming, messy, disorganized, and demanding of personal resources. In contrast with those with caseloads higher than legally mandated, some workers reported having lower caseloads that required greater management, time, and travel. For example, a substance abuse recovery home director explained the many different tasks she and her staff assisted with while recovering women were placed there by drug court. She shared,

We get to start to put the pieces back together, whether it’s [helping clients] finding SNAP [Supplemental Nutrition Assistance Program], get them signed up for food assistance, getting them on a medical card so they can start taking care of themselves. If they have requirements from drug court to obtain employment, and then they have stipulations in trying to get their kids back, we’ll facilitate and work to get their parenting classes started and work a lot on time management.

In addition to creating a treatment program or following a court-ordered plan, workers commonly did home evaluations, found resources for clients, followed up with them to make sure they were adhering to the plan, and then went to court to report to a judge whether and how well parents were completing their programs. They might also be required to find emergency temporary placements and foster care for children, communicate with police, and supervise visits between parents and children, all while filling out the forms required for all of these things and more, including reimbursement for travel expenses for the hundreds of miles many traveled each week. Case workers talked about the costs of personal vehicle maintenance and gas, competing demands on their own time, and the conflict between filling out a home evaluation form properly and listening attentively to a parent or child. Bureaucratic demands for paperwork were compounded by pressures to meet time lines and clear cases (i.e., get them through the court system or safely reach the point of closure). Working unpaid overtime was the norm, and despite workers’ best efforts, the quality and amount of time devoted to each family was often compromised by heavy caseloads and competing demands on their time, energy, and expertise.

The pressure of meeting the needs of families in crisis was not limited to care workers but affected everyone we interviewed. Most workers fulfilled multiple roles, such as those described above and more. For example, in response to the question, “How do you balance your role when you have maybe 20 families you’re working with at the same time?,” a drug court official shared, “It’s about 45 [families]. It’s constantly all day managing and helping participants. Sometimes the hectic part is touching base with people because they may call me back, but I’m in court. They may call me back, but I’m in group. My job is to do all of that.” This official’s experience demonstrated how competing work demands further complicated available time for and focus on client needs. Attending meetings, making and taking phone calls, filling out required forms, and responding to a constant barrage of e-mails was time consuming and mentally challenging. Participants described work days that ran long due to acute crises and cases that fell through the cracks because of the more intensive needs of other clients.

The lack of resources and adequate staff made collaboration difficult, leading to high levels of “burn out” and employee turnover, which further compounded the problem. One police officer, whose job was to investigate cases of child sexual abuse, exemplifies the problems of high caseloads and insufficient resources and staffing. He said,

When I was working sex abuse, I developed really good relationships with all the social workers. I knew them all by name, I had their numbers in my phone, we worked really close, we were a family. But that’s also why after two years I said I was either going to quit this job, or I was going to promote out of it, or I was going to jump off the roof. It was bad. It was like I had eight wives. They were chasing me all the time. They had a few [sexual abuse] cases. I had eight counties’ worth. Their emails were coming in at such a rate it was hard to manage. It was too much.

The professionals in our study expressed discouragement and exasperation in response to the multiple and often conflicting demands on their time and personal resources. No one mentioned issues with pay. We did not ask directly about compensation, but made sure that participants could mention it along with the other issues they raised. Rather, the major sources of frustration were high caseloads, under staffing, a lack of resources required to provide the services desperately needed by parents and children, and the pervasive “red tape,” including the ways they felt enacting care work as paid organizational work restricted opportunities to actually care for the needs of their clientele. Our assessment is that among those who were still employed in the system, complaints did not originate with being underpaid, but rather with lack of resources and the pervasive need to meet bureaucratic demands for a paper trail and to meet what we conceptualize as “production quotas.”

Theme 2: The Business of Care

A major concern was the loss of focus on human needs when dedicated workers had to balance the human element of caring against the bureaucratic demand for them to document their work as part of the business of human services. Every organization associated with providing care for families and abused or neglected children is dependent upon funding, which is allocated less on the basis of community need than on organizations’ ability to document the work they have done. All services had to be documented, shifting the primary focus away from the family and orienting it toward completing the paper trail. Forms with scales, rubrics, and matrices were required for every encounter with a family. They were used to measure such factors, among others, as degrees of danger or risk for children and the extent to which a family was progressing toward court-mandated goals. Questions to be documented included the following: Did the child have any visible bruises or other signs of physical abuse (documented with drawings)? How clean was the house? Was there evidence of vermin? How much food was in the refrigerator and in the cupboards? How nutritious was the food? Did the child have a private room to sleep in or did she or he have to share with another child? If shared, with a child of the same sex? While these factors are important, the demand to see multiple families in a single day and to document each one made it extremely difficult for a worker to get to know a family, their needs, barriers to having those needs met, and even their motivations to improve the situation.

Psychologists and psychiatrists were similarly required to document their diagnoses, any medications prescribed, and progress made by clients. Participant observational data suggest that it was common for parents and their children to be interviewed by a therapist whose back was turned toward them while the professional entered data into a computer. Case workers and social workers, similarly, carried clip boards with forms that they filled out while interviewing clients. During two separate interviews with agency officials, the first author asked the following clarifying question, using phrases from their own statements. “Are you saying the business of human services sometimes gets in the way of actually doing human services?” The first official, who worked within the Department of Juvenile Justice, answered:

Oh, yeah, that’s a definitive yes. Policies of agencies are typically written to support the needs and desires of agencies, not necessarily written to support the service provision to the clients, and that’s just a natural part of the bureaucracy of any agency whether they’re government, or whatever. So, yes, I think so because it is a business, and whether it’s a for-profit or not you still have to meet your bottom line in terms of a budgetary standpoint. You still have a governing body that establishes expectations or standards that you have to meet and comply with, so yes. I think it does get in the way sometimes.

In addition to shifting the focus away from clients, the paperwork also consumed time and resources, which could not then be spent meeting families’ needs. While answering a follow-up question, a specialized services center director discussed the minutiae of bureaucracy and further contextualized the ways the concrete business aspects of human services compete with direct services to client families. She commented,

It [human services work] is a lot of paperwork and checks and balances. If we have a therapist who’s doing therapy today, they break down what they do in 15-minute intervals. So if they take a phone call, that’s 15 minutes, then with that client [there is]15 minutes, and they have to put it [their time intervals] on this sheet of paper and that on that sheet of paper, and that one has to go to the administrative assistant who enters it into our system which then in turn eventually matches their timesheet that’s also broken down and takes a long time to fill out, to go back and pull up all your reports to see which funder paid for what and how long you worked on that funder’s stuff that day . . . Some of the reporting, especially the reporting and tracking of that information, can take away from the services that we provide on a daily basis.

Both sentiments illustrate how human services work has become increasingly bureaucratized to the extent that a bulk of service hours, meaning both the physical and mental energy of professionals, is invested in accountability measures, budgeting, and outcomes tracking that may inhibit the personal commitment and care of human services professionals. A statement by a foster care case manager, the majority of whose time was spent coordinating schedules and filling out forms, is indicative of competing demands care workers encounter. She said,

I’ve been pushed into a role of paperwork. I’m the paperwork maven. I’ve got my big board of dates that I keep track of and I’ve been put into that niche. My passion is training [families] and I want to be out [with them]. It’s frustrating!

All of the professionals interviewed for this project were required to document the work they did so that the demands of funding agencies, insurance companies, state and federal government, and other entities could be met. A school-based family case worker explained,

So, there’s a director at the state level and a district contact region to region. My boss reports to her and we have to submit that grant paperwork that shows we’re doing things over a certain period. In addition, coordinators have to go to training to be taught how to use this language when they show what they’re doing.

Without the necessary forms, filled out properly and in a timely manner, the funding necessary to protect children and help families would cease. Yet the very forms and schedules that made the business of caring possible detracted from and made care work more difficult.

Theme 3: Production Goals

In addition to the paperwork required of employees, families were under court order to achieve specific goals within a set amount of time. While judges had flexibility in assessing whether parents had made satisfactory progress toward a goal to warrant an extension of time or the right to keep or have their children returned to them, workers were evaluated by their ability to meet mandated goals, just as agencies and organizations were judged by their productivity in delivering services. Goal attainment was evaluated quantitatively, based on how many cases were closed in a month. A case was considered closed if one or more of the following conditions had been met: (1) An investigation of alleged abuse occurred, and no evidence of abuse or neglect was found; (2) parental rights were terminated when parents failed to meet court-ordered goals; and (3) parents met court-ordered conditions and were permitted to keep their children or had their parental rights restored. Workers were pressured to be efficient in getting cases closed, leaving them less flexibility in helping families reach their goals and reducing their ability to exercise an ethic of care in working with parents. One court worker commented,

So many of us have so many people who we’re trying to help and want to get everything done yesterday, but there’s only 24 hours in a day. So trying to be mindful of that . . ., sometimes a court system doesn’t wait on us, and that we have to get things done under certain deadlines.

Working under deadlines and what we conceptualize as “production goals” also made collaboration difficult among agencies, many of whom were competing for the same grants and other sources of funding. This competition had the potential to impede the cooperation intended in collaborative exchanges, along with frank and open communication among agencies. An agency director, complaining about the competitive nature of protecting children, commented, “We ought to be talking to one another because, especially in social services, we’re dealing with people’s lives.” His emphasis on the idea that human services extend beyond traditional business models and proprietary for-profit services demonstrates how the human element of human services is a driving force within care work that potentially can become secondary to bureaucratic demands.

In contrast, one participant strongly asserted that the bureaucratic frameworks and increasingly privatized dimensions of human service systems, while at times constraining, were also ethical obligations entrenched in care. He described how these bureaucratic features of human service organizations make care work possible. The participant, a family counselor, stated,

Can human services be both beneficial and a business? I think it depends on what your definition of what a business is for. Is it wrong to make money? Absolutely not. Is it wrong to make money because people have pain and suffering? It comes back to providing, filling a need. . . People need to be heard. People need to be validated. People need help. People need to know they have some choices. People need someone who is an expert. There are ways to guide them in a way that moves beyond their defenses and helps to get to them, people need that, and, if you’re good at it, charge whatever you want to charge. People will come. You’ll know when you don’t have any clients that you’re charging too much. This is the ethical thing. Ethically speaking, if I’m a private practitioner I have to have the lights on, I have to have the doors open. . . I have to have a car, I have to have a home, I have to have all these things because I have a hundred people who come to me for therapy. Anyone who says I don’t have an ethical obligation to make money and manage money is flat out wrong.

This counselor’s comment illustrates how, for some, the bureaucratic structure of human services is viewed as an ethical necessity that provides a pathway through which individuals with needs can access expert care. His position on the ethics of bureaucracy diverged from the majority of participants who described bureaucratic constraints as limits to their ethics of care; however, this counter narrative is an important demonstration of what has been discussed in previous literature as the ways in which bureaucracy can also galvanize social action and social change (Clegg, Courpasson, and Phillips 2006). Without salaries, mileage reimbursements, administrative budgets, and other monetary incentives, professionals would be unable to provide needed assistance and vulnerable families and children would be at risk. All the same, bureaucratic dictates put enormous demands on professionals to fill out a plethora of forms and to document the minutiae of their work lives. Bureaucratic constraints such as these reveal how human services are situated within a contested space, a space occupied by the tensions within intersectional, gendered, organizational processes.

Theme 4: Collaborative Relationships and Burnout

Every participant interviewed emphasized the importance of building collaborative relationships. We conceptualize such relationships as a form of “social capital” that functioned in multiple ways that worked to bridge, accelerate, and enhance collaborative networking (Wallis 1998). Having relationships made initiating and participating in collaboration easier and more effective. Established relationships motivated participants to engage in interagency collaborations, and a lack of such social capital was mentioned as a reason for poor collaboration. Within school systems, in particular, safety concerns were regularly reported by teachers, administrators, and family service center staff as mandated by school policy and by state laws. The regularity of reporting, especially for elementary-aged children, necessitates effective collaboration and partnering between schools and local human service organizations, primarily CPS. Referring to the problems that care workers commonly encountered and the complications a lack of established relationships can create, one family service center coordinator who worked in an area school said,

Social services has a lot of new staff. The ones who have been there for a while know that we have a lot of background with the families. So sometimes, if they just hired the new ones, they say, “Oh, we can’t talk to you.” Because we usually share with them what we know and they share with us . . . We have a good relationship with the old workers, but the new workers go to the guidance counselor instead of coming to us. They probably think she’s in on it, but she don’t know.

By going to the guidance counselor, a professional trained to focus on meeting the educational needs of students, rather than family service center workers who are tasked with meeting the non-educational, personal needs of at-risk children and families, essential time and critical information may be lost. These types of distinctions are important for two reasons. First, having collaborative relationships means knowing who you can talk to and what kind of sensitive information can be shared across organizational (and thus policy, or bureaucratic, boundaries). Second, safety concerns, especially for young children, are time-sensitive, and having effective collaborative relationships in place greatly enhances a community’s protective capacity. For both reasons, the challenge of collaborating with inexperienced care workers adds to the complex pressures of meeting child and family needs.

Professional relationships among different agencies allow human service workers to know whom to call, the roles of various professionals involved, and which professional has the expertise needed to “fit” the crisis situation at hand. The interworking of human services, including building a network of professional contacts and navigating the landscape of a local community of ever-changing organizations, programs, and staff can be a very steep learning curve for those new to the profession. As much as such social capital is needed in order for the child welfare system to work effectively, the multitiered bureaucratic demands of human service organizations inherently prevent such vital relationships from being synergized in collaboratively productive ways. For example, a judicial case manager observed:

Turnover is high. Turnover at the [state level] is high. Turnover in non-profits is high. Turnover in therapists who work for therapeutic foster homes is high. I don’t know why. . . . and the way those contracts are set up, they’re only supposed to use therapists within their company, and so sometimes kids go without services because they’re in the process of hiring a new therapist, and then they get that therapist in and that delays sending them home because it delays their report [to the court].

Her description illustrates how a high rate of turnover produces instability and consistent flux within a service community that relies upon the ability to build and maintain relationships with knowledgeable professionals equipped to deal with a crisis-oriented service population. Although high turnover was viewed as problematic, yet normal, within the stressful ecology of care work, a vast majority of participants voiced concerns related to the rate at which they encountered new workers.

One human services worker described his experience of beginning his professional work in a rural CPS office. He completed a social work degree because of his desire to “help people in need,” but very quickly his role became overwhelming, isolating, constrictive, and constrained by competing bureaucratic priorities and a lack of access to necessary community resources. As a CPS worker in a rural county, he described how his caseload was made up of all types of CPS cases from investigations, including ongoing cases, foster care case management, and residential oversight, “everything all at once.” After several years of working in a rural CPS environment, he moved to a more urban human services organization. While describing his experiences of working in both settings, he commented,

I’m in the middle. I’m like stressed out, working on Saturdays off the clock, my blood pressure is up, I gained like 80 pounds. I can do all that stuff, thinking like, “How can I make something happen on a bigger level. I need to do something else. This work is going to kill me. ” [emphasis added by authors]. Or, you can leave, or you can be so crisp and burned out that you don’t even respond to emails. The nature of [CPS] is that unless you cheat on your time sheet or your travel, you ain’t getting fired, and that’s just the truth. So, like you can just be . . . , they call it performance punishment, that’s what it’s called. Your reward for working honestly and ethically is more work or you get all the referrals from judges and law enforcement which is like six [referrals] in one.

This care worker’s account illustrates how bureaucratically structured human service environments can lead some employees to feel burned out and unmotivated to do the work of the organization—the critical, often life-saving work of serving vulnerable families and children in crisis. He, like many other participants, described how bureaucratic stressors within his previous organization led some workers to shift their concerns away from a focus on caring and to prioritize concerns about professional accountability and liability instead. He continued,

The ethics of day-to-day practice were underneath concerns about liability, just given the bureaucracy and the whole nature of it . . . That’s why people leave. They’re gone. They burn out. . . You realize that it’s an effective strategy to not do quality work. You realize that. The way that the system is they’re [families] at the very bottom.

Prioritizing concerns about professional liability, meaning the risk of personal and organizational litigation in the event of practitioner negligence or malpractice, were not only at odds with an ethic of care, but also displaced professional investment in exerting care through human services work, especially within the CPS and similar human service contexts (Reamer 2001). This CPS worker explained,

How can we find individuals who are willing to say, “What’s right is right, and I’m just going to do what I have to do to protect a child?” Or, to stand up and say, “I disagree, Your Honor. This is what I’ve seen,” because often the child welfare workforce, some of them that are trying to do their best are isolated and alienated, and they’re like trying to keep their head above water, . . . but the end result is you have a few people that are probably burned out that are doing the same daggone thing every day, and they’re probably not willing or not able to stand up and say, “Look, it is what it is. I don’t care. We’re going to put this in writing because the child deserves better than this.”

Discussion and Conclusion

The concept of power is essential for understanding organizational processes of cross-sector exchange between human service organizations engaged in integrated care work through interagency collaboration (Gray 1989; Rice, Zwarenstein, Conn, Kenaszchuk, Russell, and Reeves 2010). As previously explained, behavior within and between organizations reflects cultural ideals, beliefs, norms, and dominant ideological assumptions about client families and their needs as embedded in social policy; therefore, power relations and institutionalized inequalities are also present during collaboration (Dominelli and Campling 2002; Smith 2017). We contend that differential power relationships among collaborating human service organizations as well as between human service organizations and recipient client families results from a conflict between ethics of care and ethics of justice in the form of bureaucracy and the complexities of organizational policies and law. Ethics of justice are also present in more contemporary corporate business models of for-profit human services contracts, programs, and organizations that focus more on “profits rather than people” (Dominelli and Campling 2002:3). Bureaucracy as imposed upon human services through law, social policy, and organizational mandates, even when imbued with power through what Richardson (2015) refers to as moral legitimacy, may inadvertently negate and undermine the caring intentions of professional care work. This conflict is inherent within the social structures and the social interactions of integrated human services organizations.

Our data show that professionals engaged in care work across a diverse array of human service organizations shared similar concerns about the deep-level impacts of bureaucratization upon their daily work experiences. While the courts, law, funding agencies, and government entities require accountability, our data suggest that paperwork and clearing cases often takes bureaucratic precedence over the work of supporting families and protecting children. Thus, it is critical to find ways to balance ethics of care against the imposition of systemic bureaucratic constraints, especially within human services. Doing so is an important social policy issue and a question of social justice.

The seriousness of child maltreatment means that the cultural practices of human services need to be reconsidered, re-interpreted, and revised. Our study offers opportunity to critically reflect upon everyday interpretations of organizational processes, including interagency collaboration, and the conflicting demands of a highly rationalized bureaucratic system that is based on an ethic of justice and the agencies and employees working to stabilize families and protect children, working from an ethic of care. We hope our work prompts scholars and policymakers to consider the ways in which the social practices of human services can both empower and constrain the outcomes we so desperately seek—primarily the protection of vulnerable children from initial or recurrent harm. Acknowledging forms of bureaucratic power is an important step closer to reconnecting with the ethics of care as a pathway to achieving such a critical policy goal.

Recommendations

The study findings lead us to propose a number of recommendations with policy implications. These recommendations are representative of participants’ experiences of invested and engaged professional care work across a spectrum of integrated and collaborative human services programs, agencies, and organizations. We suggest their experiences are generalizable beyond the localized communities in which their services were situated and beyond the scope of CPS; therefore, our recommendations offer an opportunity for many different types of organizations to reflect upon the policies and practices that shape their impact on clients or consumers alike. Our recommendations offer opportunities to decentralize gendered power within bureaucratic settings and open a more equitable domain of collaboration and support.

(1) Explore ways to reduce paperwork overload. Care workers are inundated with forms, reports, and other forms of documentation, which, as necessary as they may be perceived as being, are sources of overload, distraction, and burnout.

(2) Take advantage of technological options for documentation and data collection. One way to potentially reduce the burden of paperwork inundation is to explore technological options for documenting work tasks and collecting essential data.

(3) Invest in collaborative data sharing opportunities that will allow integrated human services organizations to access client documentation that is normally requested and shared. Doing so reduces duplicative processes and forms and also reduces the number of times clients repeatedly share their referral information.

(4) Engage and collaborate with direct care workers and allow their experiences to inform and modify policy and procedure guidelines.

(5) Create a support system specifically for burnout prevention and include resilience education and training. As several recent social work and medical studies have shown, providing strengths-based resilience education and training, especially for beginning human services professionals, is key to building a reserve of optimism and resilience which may help to emotionally insulate care workers and prevent burnout (McFadden, Campbell, and Taylor 2015; Skovholt and Trotter-Mathison 2014; van Breda 2018). Furthermore, acknowledging structural barriers within human services organizations and their contribution to work overload and stress may reduce the guilt and stigma care workers feel when they experience role strain, the sense that they are not successfully fulfilling their professional role.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Christa J. Moore

Author Biographies

Christa J. Moore is an assistant professor of sociology at The University of Virginia’s College at Wise. Her qualitative research focuses on child welfare, human services, and the influence of gender and power during interagency collaboration in rural communities. She has over 20 years of human services experience primarily in the areas of child protection and crisis intervention with families. She currently teaches courses in clinical sociology, human services, gender, marriage and family, and social inequality, among other undergraduate offerings. Her teaching, applied research, and service initiatives are community-engaged and seek to promote the prevention of child maltreatment through enhanced collaboration strategies.

Patricia Gagné is a professor of sociology at the University of Louisville. She is a qualitative methodologist whose research has focused broadly on issues of gender. Her publications include articles on survivors of intimate partner violence, the challenges and lived experiences of transgender people, and the empowerment women serious motorcyclists experience when they face the challenges of serious edgework leisure, among numerous others. One of the most rewarding aspects of her career has been working with graduate students to help them get their research published. She teaches courses in sociological theory and has long taught the graduate seminar in qualitative methods.

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