Concord — It was midweek and Demetrios Tsaros’ caseload was already becoming hard to handle. He had to investigate three new reports of child neglect — two for parents’ substance abuse and another for mental health concerns. But first, he had to decide whether to go to court and petition to remove a teen at risk of physical abuse from his home.
“It quite literally often feels like there are 11 holes in the dike and I only have 10 fingers,” said Tsaros, who works in Manchester for the state’s Division for Children, Youth and Families. “That’s not unique to me. It could be any worker, on any given day.”
New Hampshire has among the lowest number of child protection workers per capita nationwide and ranks top five in the country for highest worker caseloads, according to a Monitor analysis of the most recent available data from 2014.
While national standards recommend child protection workers investigate no more than 12 reports of abuse or neglect at one time, New Hampshire’s DCYF staff can have an average monthly caseload of 54 reports, according to an outside review of the agency released last year.
The lack of staff and crushing workloads have led to high turnover and low morale at DCYF. The quality of work has suffered too, potentially putting children at risk, because staff don’t have time to always follow up with families and conduct in-depth investigations, former workers said. New Hampshire substantiates roughly 5 percent of abuse and neglect reports, the lowest rate in the country and far behind the national average of 19 percent, federal data shows.
“You are passionate about helping families. At the end of the day when you feel like you are not getting that done, it’s a horrible feeling,” said Laurie Pelletier, who left DCYF last year after working there nearly 16 years.
DCYF has come under scrutiny after two toddlers under agency watch were murdered by their mothers within a year.
The agency is asking for more staff in the next state budget after an independent review released last year found that DCYF doesn’t have enough workers to keep up with incoming reports of abuse and neglect. It’s the first time in at least five years DCYF has requested more staff, even though the number of child abuse and neglect reports has risen steadily during that time, records show.
“A number of things may have occurred in the past,” said Department of Health and Human Services Commissioner Jeffrey Meyers. “But I want to look forward and work with the Legislature and the governor now.”
New Hampshire doesn’t limit child protection workers’ caseloads in their contracts or under state law. DCYF staff surveyed for the outside review reported they were assigned an average of 15 new investigations a month.
More than 10,500 reports of abuse or neglect came in for investigation during the 2016 fiscal year, up more than 20 percent from 2011, according to DCYF data. The rise is driven in large part by the state’s ongoing opioid crisis, which led to nearly 500 overdose deaths last year. DCYF has seen a spike in the number of infants born exposed to drugs, from 367 cases in 2014 to 504 a year later.
To manage the increase, DCYF has at times reassigned other workers within the agency to help investigate abuse reports, Pelletier said.
DCYF has roughly 85 child protection workers, spread across 11 district offices statewide, who visit homes to investigate reports of abuse and neglect that have already made it through a round of screening. At any given time, however, roughly 30 percent of the workforce is out on leave, in training or leaving a position vacant, meaning the bulk up of the work is shouldered by about 56 workers, the independent review found.
Depending on a report’s severity level, staff has up to 72 hours to meet with the child victim in person. They are supposed to talk to the victim’s siblings; both parents; and at least two people outside the home, such as doctors, teachers or neighbors, to determine whether the abuse allegations have merit. Under policy, the report is required to be closed or acted upon within 60 days.
But that rarely happens. Only one out of five investigations was completed within the 60-day time frame, the review found.
Tsaros has juggled more than 150 open investigations at times because the paperwork needed to close them often falls to the bottom of his priority list, behind checking in on children and conducting interviews, he said.
“I don’t have time because I am dealing with new reports coming in,” he said. “There’s constantly a number of different factors pulling workers in different directions. The best days at work are when I am allowed to do my job.”
The ideal is visiting a family more than once during an investigation to build a relationship and even if the report is unsubstantiated, to help parents or children access mental health services or addiction treatment they may need. Right now, DCYF workers are often checking in on a family just once to make sure the child isn’t in immediate danger, then moving on, former staff said.
“It’s triage,” Tsaros said. “I am doing the best I can with the limited time and resources.”
National data show New Hampshire has five child protection workers for every 100,000 people, half the national average of 10. And New Hampshire falls behind most of its New England neighbors when it comes to child protection workers per capita, according to the 2014 data from the federal Children’s Bureau. Maine has nine and Vermont has 11, while Massachusetts also has five for every 100,000 residents.
That same year, New Hampshire ranked fifth in the country for highest caseloads per worker. State child protection workers completed an average 139 abuse investigations in 2014, compared to the national average of 67 per worker, according to Children’s Bureau data.
Caseloads began rising roughly five years ago, workers said, but there have been few resources to help them manage.
Unlike other state agencies, DCYF workers are compensated with time — not extra money — for logging overtime hours. Tsaros made $50,634 in regular pay last year, and $2,197 in holiday pay. By comparison, many state police troopers and guards at the state prison make more than double that amount with overtime and special pay.
At DCYF, overtime hours are approved only for fieldwork, like court or family visits, not paperwork, staff said. The result is that open investigations can languish for months without any action because the final documentation is incomplete. The agency now faces a backlog of roughly 2,800 overdue investigations, which it is trying to shrink by giving workers up to four hours of paid overtime a week to close cases.
Burnout has become a leading factor in staff turnover at the agency, which has reached 50 percent over the last few years, the agency has said.
“All of them are feeling so overwhelmed and so under-the-gun all the time they are literally in triage mode,” Pelletier said, who said she left DCYF last year after the stress of the job became all-consuming.
Some of the longest-tenured child protection workers have departed.
Tsaros, with six years on the job, is the most experienced worker at the Manchester office who investigates abuse and neglect, he said. Behind Tsaros, the second most experienced DCYF worker has been there three years, he said.
Newer workers typically shadow more experienced ones in their first weeks on the job to learn the ropes. As seasoned child protection workers leave, the training resources diminish.
It takes about two to three years to get confident and comfortable investigating child abuse, Pelletier said. Workers often deal with tragic or frightening situations on a daily basis and need to learn how to cope.
Tsaros came to child protection after working in juvenile justice and law enforcement. It’s the mission of protecting children that keeps DCYF workers going, he said.
“After all is said and done, when you can get a kid out of a dangerous or harmful situation and place them somewhere that’s safe and caring, there’s really no more righteous thing a person can do.”
Tomorrow: How far along is the state in its effort to reform the embattled agency?