154 kids, 1 case manager: Hillsborough’s foster care staff crisis.

There aren’t enough workers to care for children and help families in Hillsborough County’s child welfare system.
Eckerd Connects Community Alternative building in Tampa. Nonprofits that work with the foster care agency are struggling to hire and retain case managers leaving those who remain badly overburdened with cases.
Eckerd Connects Community Alternative building in Tampa. Nonprofits that work with the foster care agency are struggling to hire and retain case managers leaving those who remain badly overburdened with cases. [ IVY CEBALLO | Times ]
Published Feb. 11, 2022|Updated Feb. 11, 2022

TAMPA — The care and safety of foster children depend on their case manager.

They make sure foster kids attend school, receive counseling and medical treatment. They supervise visits with parents and siblings. Case managers also attend the child’s court hearings and, by law, must set eyes on the child under their care at least once a month. On top of all that, it’s their job to make sure parents follow the court’s plan to get their children back.

It’s a heavy burden, which is why the Child Welfare League of America recommends that those in the job oversee no more than 17 cases at a time.

But in Hillsborough County, child welfare experts are sounding the alarm that case managers are overburdened with dozens of cases, kids and families.

An internal report reviewed by the Tampa Bay Times showed LifeStream Behavioral Center, one of four nonprofits that provides case managers to Hillsborough’s primary foster care agency Eckerd Connects, had seven employees managing 80 or more children and four responsible for at least 90.

One caseworker juggled 154 foster kids.

If that employee worked 10-hour days, they would only have 80 minutes a month to check on each child — hardly enough time to conduct home visits, go to court and check on their well-being.

Related: Hillsborough’s $87 million foster care contract has just 1 bidder

The problem is a shortage of case managers. Hillsborough has only 112 overseeing more than 3,100 children who are either in foster care, staying with relatives or being supervised because of concerns about abuse or neglect, according to Eckerd Connects data.

LifeStream is budgeted to hire 48 case managers but had only 13 on staff as of Feb. 7, according to state data. Three of those were in training and ineligible to take on cases. While each case typically involves one set of parents and all their children, the internal report produced last month by Eckerd Connects, cites the actual number of foster children under supervision.

“It’s extraordinarily concerning and, frankly, dangerous for children in Hillsborough County,” said Robin Rosenberg, deputy director of Florida’s Children First, an advocacy organization.

What is happening in Hillsborough is happening across Florida as counties struggle to retain and recruit foster-care case managers. Nearly 600 case-manager positions statewide — around 40 percent of the budgeted workforce — are either vacant or filled by someone who hasn’t completed the necessary training to manage cases, said Kurt Kelley, president of the Florida Coalition for Children, a group that lobbies on behalf of primary foster agencies like Eckerd Connects.

’Stretched too thin’

Hillsborough’s overburdened case managers are struggling to do their jobs. Only 25.1 percent of children entering foster care in Hillsborough leave within a year, the second-lowest rate among Florida’s 19 child welfare circuits. That is well below the state’s target of 40.5 percent. Children whose cases are handled by LifeStream Behavioral Center case managers fare even worse with 18 percent exiting foster care within a year. That’s despite the county having about 200 fewer children in foster care since the end of 2018.

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Rosenberg said foster parents have told her that some case managers have delegated their monthly visits with a foster child to other case managers, who fit the trip in during lunch breaks or after work. She is worried that case managers won’t have enough time to work with parents, increasing the risk that children will languish longer in the system.

Eckerd Connects Community Alternative building in Tampa pictured on Tuesday, Feb. 8, 2022.
Eckerd Connects Community Alternative building in Tampa pictured on Tuesday, Feb. 8, 2022. [ IVY CEBALLO | Times ]

Some parents already are missing court-ordered visits with their children, lawyers recently told Hillsborough Circuit Judge Katherine Essrig, who oversees dependency court. Case-manager visits with parents should typically start within 72 hours of a child being removed and are considered vital to reassure distressed children that they have not been abandoned. The judge said lawyers told her some of those still haven’t taken place weeks later.

“It’s evident to all who work in the system there are too few caseworkers and those working are stretched too thin,” Essrig said. “It’s very difficult, if not impossible, for them to do their job properly.”

Eckerd Connects sends weekly reports to the Florida Department of Children and Families that flag how many workers have caseloads above 25 and 30 children. That includes the Jan. 14 report that noted one manager was supervising 154 children.

After the Times inquired about the situation in Hillsborough, the state agency announced it would send its workers to conduct welfare checks on children whose case managers are overburdened.

’We have to be more competitive’

An estimated 33 million workers have quit their jobs since spring 2021 in what has become known as the “Great Resignation.”

That has left companies and agencies struggling to recruit and retain employees.

The foster-care sector may be more vulnerable than most, Kelley said. The average starting annual salary for Florida case managers is around $38,000. That’s not competitive for a demanding, high-stress job that involves working with parents who may be emotional, if not hostile, about having their children removed, Kelley said.

“They can now go and get a different type of work for more money and have fewer threats on their lives and less stress,” he said. “We have to be more competitive and have to make sure we have a well of workforce resources.”

Reports show Hillsborough case managers have been quitting in droves. The turnover rate at LifeStream was almost 150 percent for the past year; across the county, the rate was 138 percent.

“The cost of (employee) turnover is absolutely debilitating to our system of care,” Kelley said.

In a joint statement, officials from Eckerd Connects and LifeStream cited the pandemic and the job market as factors in the shortage of case managers.

“The COVID-19 pandemic has presented unparalleled staffing challenges for employers across the country, including in the child welfare system in Florida,” the statement reads. “Case manager turnover is an ongoing challenge for many child welfare agencies, as most resign within three years of employment, and is not isolated to the Tampa Bay area.”

Eckerd Connects is taking steps to relieve the pressure on LifeStream, said spokesperson Ron Bartlett. In March, the agency started an in-house case-management unit and transferred 347 children from LifeStream. The nonprofit was taken out of the rotation to accept new foster children for four weeks in late 2021. And it hasn’t taken on any new cases in about a month.

Bartlett said Eckerd Connects plans to transfer 200 more children to its in-house case management team.

‘We can stop the drain’

The state put Eckerd Connects under a corrective action plan in 2018 for several issues it found in Hillsborough, including its failure to find placements for teens who end up sleeping in offices and for not maintaining adequate staffing levels.

The state agency announced in November that it would not renew Eckerd Connects’ $80 million contract to run foster care in Pinellas and Pasco counties. The decision came after Pinellas Sheriff Bob Gualtieri said he intended to launch a criminal investigation into the nonprofit, which allowed children to sleep in “deplorable conditions” in unlicensed offices.

Related: Eckerd Connects loses child welfare contract in Pinellas, Pasco

One child living in an Eckerd Connects’ office was hospitalized after falling off a ladder and cutting open his stomach while trying to climb onto the roof, Gualtieri said. Another overdosed on someone else’s prescription medication.

The nonprofit responded to the loss of its contract in Pinellas and Pasco by announcing it would walk away from its $87 million Hillsborough contract when it expires June 30.

“The Department expects Eckerd to fulfill its contractual obligations by continuously ensuring an adequate number of qualified and trained staff are available to provide services,” said Department of Children and Families spokesperson Laura Walthall in an email, “but unfortunately, it once again appears that Eckerd is failing to meet the needs of the community.”

Florida law does not mandate a specific ratio of foster children to caseworkers, but it does require the Department of Children and Families to give foster agencies sufficient funding so case managers are not assigned more than 19 cases.

Related: Hillsborough loses big as state fails to divide child welfare money by need

Foster care agencies have complained they don’t get enough money to meet that target and that state funds are not allocated based on the number of children served. That is the result of a 2015 rule intended to shield agencies from declines in funding when the number of children they serve falls.

But it also meant there was no guarantee that those agencies would receive extra funds when foster-care populations rose, which is what has happened in Hillsborough, Pinellas and Pasco counties over the past five years.

One foster care provider that has taken steps to tackle the case-manager turnover crisis is the Citrus Family Care Network, which runs the child welfare system in Miami-Dade and Monroe counties.

Its foster population has fallen by several thousand over the past seven years. Because its funding has remained steady, however, it has been able to increase the starting salary for case managers by about $10,000 to $52,000. The agency reports that its case manager turnover rate averaged 4.2 percent over the past 12 months. The average caseload for each worker was about 16 children.

“All of a sudden they got tremendous applicants and they’re not losing anybody,” said Kelley, the lobbyist for lead agencies.

He said the preliminary budget proposed in the Florida House in this year’s legislative session includes an additional $127 million for the child welfare system. If that is matched in the state Senate, it would mean the Department of Children and Families could fully fund every agency based on the number of children they serve.

That would include funding to hire more case managers and pay higher salaries, he said.

“This is something that no one could have foreseen — this came upon us so strong and so fast,” Kelley said. “I’m convinced if we get the money in the right place, we can stop the drain.”