The North Carolina Department of Health and Human Services, including the Division of Health Services regulation that monitors adult care homes, is housed on the campus of the former Dorthea Dix state mental hospital in Raleigh. Frank Taylor / Carolina Public Press

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Child Protective Services workers often see families on the worst days of their lives.

The tools available to social workers, and the practices they follow in communities across North Carolina when deciding what to do with a child in a troubling situation, result in inconsistent application of state law and policies, a research arm of the N.C. General Assembly said in a report late last year.

The Program Evaluation Division’s November report raised alarms with legislators, who lodged their concerns during a January meeting and approved draft legislation for a future legislative session.

Monitoring of child welfare in each county by the N.C. Department of Health and Human Services “lacks statistical validity and fails to ascertain the quality of county-level intake screening,” said an evaluator for the Program Evaluation Division during that January hearing.

“The absence of accurate program data compromises DHHS’ ability to oversee county Child Protective Services.”

DHHS officials, who indirectly oversee local Department of Social Services offices in the state’s 100 counties, to some extent agree with some of the findings.

Parents have wide constitutional authority to raise children as they see fit. As such, taking children from their parents is usually considered a last resort to prevent imminent danger or maltreatment of a child. To make sure children and their situations are being treated equally, social workers are charged with following state policies.

But in nearly one in four counties, child welfare workers consider outside guidance in addition to state policy when deciding a child’s or a family’s fate in the system.

“Without a single, consistent intake policy that is utilized across all counties, children across North Carolina will not be equally and fairly protected from child abuse and neglect,” wrote DHHS Child Welfare Director Lisa Cauley and DHHS Assistant Secretary of County Operations Susan G. Osborne, in response to the report.

The report also outlined a range of problems that child welfare workers face on the ground, such as inconsistent or nonexistent training and retraining, a lack of timely or consistent advice from DHHS, and a cumbersome and repetitive intake form that workers fill out when taking complaints of child maltreatment.

Training and support

When a county DSS office receives a complaint about a child’s living situation or condition, policy determines whether local caseworkers investigate allegations of abuse or neglect, or whether to provide support to the family.

Child welfare workers also have to screen reports “immediately” and decide whether to respond within 24 hours or within 72 hours.

In its study, the legislature’s Program Evaluation Division asked county social workers to evaluate hypothetical child welfare complaints. Workers correctly screened allegations 71% of the time. That this rate was not much higher represents a concern in the study, which the Program Evaluation Division said stemmed from a lack of retraining requirements.

The PED said the General Assembly needs to require DHHS to use hypothetical vignettes to see if workers understand policies and assess training needs.

DHHS needs to “provide more intake training opportunities for county workers and require periodic retraining,” the PED said.

DSS directors organization responds

However, an organization representing the interests of county directors of social services disagreed with the study’s approach.

The vignette exercise was not realistic and does not reflect the actual experience of how child welfare workers do their jobs, said Kim Harrell, president of the N.C. Association of County Directors of Social Services.

In a written response, Harrell said the evaluation “highlighted a number of challenges and inconsistencies with the North Carolina Child Welfare intake screening system.”

State policy already forbids workers from deciding by themselves how a case should be screened, Harrell’s letter said. The policy requires “a two-level decision-making process for every allegation received,” the letter said.

“Requiring two persons to jointly evaluate the (abuse or neglect) report and review the tools/policy contributes to more consistent screening than reflected in the PED Evaluation,” she wrote.

Workers on real cases can also call complainants back to ask follow-up questions, Harrell wrote.

County social workers also have “inconsistent and untimely state guidance,” said the PED report, which recommended a rapid response hotline staffed by experienced child welfare workers for county workers to call if they have questions about child welfare cases.

But Harrell cautioned that a hotline needed to have an immediate response to be most useful to child welfare workers trying to navigate a crisis, and it should be staffed with an experienced intake expert.

“In North Carolina, agencies are required to screen the reports immediately, and implementing a 24-hour consultation response leaves children vulnerable and at risk,” Harrell wrote.

“The potential for inconsistency in guidance is of concern to county agencies.”

The directors association said it supports more training for child welfare workers, which should include definitions of child maltreatment and will help workers determine the difference between neglect and “inappropriate parenting,” Harrell’s letter said.

Who’s playing by their own rules?

Counties are all supposed to use the same policies to screen abuse and neglect reports. But the PED’s report says 22 counties use extra measures to decide.

Which of those 22 counties are using outside guidance? The Program Evaluation Division has so far refused Carolina Public Press’ records request for the information, saying the agency, as an arm of the General Assembly, is not required to comply with state public records laws.

CPP also asked DHHS which counties were using outside guidance to screen child welfare cases. Kelly Connor Haight, a spokeswoman with the agency, told CPP to talk to the Program Evaluation Division since it was not DHHS’ report.

After a back-and-forth, Haight said, “DHHS is aware that some counties use community standards adopted by their Community Child Protection Teams. This practice is not recommended, as NCDHHS has published policy that outlines procedures for county child welfare agencies to follow when screening reports of child abuse and/or neglect.”

When DHHS discovers any county that uses additional screening, Haight said, the county receives “technical assistance” from regional child welfare consultants, which can “result in on-site support or monitoring.”

Haight did not reveal which counties use these additional methods or whether the agency was aware of the extent of the problem.

During a January legislative hearing, PED lead evaluator Sarah Nienow said those 22 counties “were using documents or had processes and procedures that were in conflict with our official state policy.”

One county, which she did not name, has “an informal rule … that every referral that comes from a judge is automatically assessed,” she said.

“So that violates state policy, which would say that you apply the same criteria to this case that you would to every case.”

Some counties also use additional documents to define the terms in state policy for workers, she said, “for instance, when a child is old enough to provide supervision to other children.”

Cumbersome intake tool

For a real case, county social workers must decide how quickly to react to a complaint and which action is the proper one. State evaluators quizzed county workers on hypothetical child maltreatment cases. They correctly screened allegations 71% of the time.

“The Program Evaluation Division found that the current structured intake tool makes the reporting process lengthy and redundant and may also contribute to screening inconsistency,” the report authors wrote.

The directors association wholeheartedly concurred.

“The current tool is lengthy, and social workers completing intake training are instructed to allow approximately 45 minutes for completing the tool with (someone who reports abuse),” Harrell’s letter said.

“Over the years, questions have been added to the tool to address court opinions or new federal laws.”

Many questions are redundant, Harrell wrote. People who report abuse may be deterred from reporting future abuse if the process takes too long and asks repetitive questions.

DHHS said it is open to redesigning the intake questionnaire to reduce redundancy and focus on crucial information social workers need to make a safe decision for children and families.

A legislative solution?

Evaluators have suggested model legislation that would require worker retraining every five years, require that counties use only state guidelines to screen cases and mandate a rapid response telephone hotline for social workers trying to navigate the latest family crisis.

The legislative solution pitched in the report forbids the use of outside measures to guide which children are taken from parents and which remain at home.

N.C. Rep. Jean Farmer-Butterfield, D-Wilson, said in the January meeting that the state ought to be able to ensure DSS offices use the same intake procedures.

“They should be able to take the leadership and the guidance and the direction to make this happen,” she said at the hearing.

“I am disappointed that they are not doing it, but it happens a lot. Why? Because people don’t have enough staff and they don’t have enough time; that’s what I hear.”

She then lobbed a question at Cauley with DHHS, who was in the audience at the hearing.

“Could you address whether or not it’s a realistic expectation for the division to take the lead and make sure that there are some things that are common in terms of following state policies and procedures at all local DSS (offices)?” Farmer-Butterfield said.

Cauley turned on the microphone.

“It is the role of the Department of Health and Human Services to provide oversight to county Departments of Social Services, and it is our role to do so in intake screening, so we do have policies that do that,” Cauley said.


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Kate Martin

Kate Martin is lead investigative reporter for Carolina Public Press. Email her at kmartin@carolinapublicpress.org.

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