KNOXVILLE, Tenn. (WATE) — The Tennessee Comptroller’s Office uncovered findings in a recent audit of the Department of Child Services (DCS). The report from the audit details a variety of issues as well as comments from a survey of case managers where one said “DCS has no place for children.”

According to the Comptroller’s Office, since 2020, DCS on average has had over 8,000 children in custody each month. The children are vulnerable, often the victims of child abuse and neglect. While DCS is responsible for providing placement that meets the emotional, physical and social needs of children when they are unable to safely stay in their own homes, the office stated finding critical safety incidents and risks in several of the department’s processes, including:

  • Children may have remained in unsafe situations because management has not met established timelines for key points of child abuse and neglect investigations.
  • DCS did not ensure that reported allegations of sexual abuse, sexual harassment or lack of supervision of custodial children living in residential facilities were investigated.
  • DCS has not developed an effective and efficient process to respond to sexual abuse and harassment allegations to keep children in residential facilities safe.
  • Deficiencies in management’s Provider Quality Team (PQT) review process contributed to the PQT not identifying a questionable provider employee, to prevent his contact with children in state custody and to avoid child endangerment.

In addition, the office found that management was unable to fill positions and address the increasing turnover which resulted in a staffing crisis. The case managers’ caseloads exceeded the state maximum of 20 cases, and a crisis-level shortage of long-term placement options to meet every child’s needs resulted in an increased number of children staying in temporary settings, such as state office buildings or transitional houses.

Other findings in the comptroller’s 164 report include:

  • Rising turnover and caseloads have impacted juvenile justice case managers’ ability to make essential monthly supervision contacts with children, their families, schools and service providers for children on probation and aftercare.
  • DCS cannot ensure timely dental and medical screenings given the reliance on paper forms and manual processes to complete, review and follow up on children’s medical and dental screenings; timely screenings are critical to identifying potential health conditions and/or need for follow-up health services.

In addition, several issues found in the audit were repeated from the previous audit, with the office stating that the corrective action was not implemented and the finding was repeated for five results under the prior audit recommendations section.

A possible heavy influence in other issues is what the office called an alarming level of case manager turnover rate. While the annual turnover rate in 2018 was 15.5%, it increased through 2021 and then reached 25.9% before skyrocketing to 55.5% in 2022. According to the report, an anonymous survey of current case managers found that reasons for the high turnover are the stressful nature of the case manager’s job, like working long hours to meet the increasing caseload demands and low pay.

The report states case managers overwhelmingly responded to a need to hire more case managers and reduce caseloads so case managers can have a greater impact on the youth and families.

The average salary for case managers between level 1 at $35,713 and level 3 at $51,694. It is important to note that while these are on average, the maximum amounts are approximately $5,000-$7,000 more, meaning, some case managers could be making significantly less per year. Supervisors’ salaries average $58,919 but can also be $61,524, according to the report.

To retain case managers, DCS has increased both the starting salaries for case managers and increased salaries to retain case managers. Despite the increased pay and several other actions taken, the review of turnover data found that 97% of level 1 case managers left DCS in the 2021 calendar year.

“If management is not able to recruit and retain managers, and lower turnover levels at DCS, management risks the safety of vulnerable children who slip through the cracks because there are no case managers to help them,” the report says.

For the average regional caseloads between August 2020 and May 2022, Knox County reached over 25 cases and remained between 20-25 cases at the end of the data set. Statewide, the maximum number of cases that a case manager had was 108.

By May 2022, the report said 36.9% of caseworkers had over 20 cases and 4.2% had over 40 cases. According to the report, the Council on Accreditations standards recommend caseloads of 10-15 cases.

A graphic of the average caseloads between August 2020 and May 2022 for DCS case managers is included in the Comptroller’s audit report. (Courtesy of the Tennessee Comptroller’s Office)

Based on the recommendation of the report, DCS said it has requested an additional $15.8 million budget to increase case manager salaries significantly for the 2023-2024 year to attract personnel. DCS also said it will be implementing increased mentorship and training programs and will focus on balancing workloads between regions that have higher caseloads to those that have fewer to manage.

Although the impact on staffing is important to note, the impact on the children who rely on DCS for placement is monumental. The report states when a child is taken from a home, they are moved to a placement ranging from level one to four based on their needs. Levels one and two include foster homes, while levels three and four require psychiatric care and residential treatment facilities up to intense psychiatric stabilization treatment below a hospital level.

    The report states when case managers try to place a child in a foster home, unless they otherwise need to be placed with a residential or more secure facility, the foster family, which is approved by DCS for only certain types of placements based on age, gender, and need, can decline to accept a child. The case manager is required to contact every foster family in their region, then private providers and staff in other regions, and if there is no home for the child, the process repeats the next day.

    Sometimes, if a transitional home cannot be found, the children end up sleeping in an office building. The report states that at least one child in the Tennessee Valley region slept in an office building for 19 days.

    “In April, May and June 2022, we performed on-site visits at four regional and county office buildings and two transitional houses across the state to determine the level of care and the amenities that children received in transitional houses and office buildings. We found inconsistent quality in the facilities where the children stayed and the amenities that children received,” according to the report. “For example, a child who stays in an office building could spend time in an office cubical designed for work, but a child who stays in a transitional house will have space comparable to a living room.”

    Photos of temporary settings found during the auditor’s visits to offices. (Courtesy of the Tennessee Comptroller’s Office)

    Knox County’s Office provided food, snacks, clean clothes, shoes, backpacks and other donated items for school, according to the report.

    Other county offices provided fewer amenities to children, including the Shelby County Office, where pictures included in the report showed options of sleeping in a cubicle or a room with a few chairs and dusty floor and sparse food options.

    Formal guidance addressing transitional homes was finally implemented in July of this year, solving the issue of staff having to prepare temporary settings with no guidance on how to meet the immediate needs of the children who were removed from their homes and had no long-term housing. The report states that the guidance did not address amenities, such as food, bedding, clothing or hygiene care in temporary settings.

    In addition to children being removed for their safety, the staffing issues paired with the number of Child Abuse Hotline calls may limit the ability of case managers to respond in a timely manner. In the audit, hotline staff worked over 200,000 allegation calls and had to assign each allegation to the proper next step. Of these calls, a little under half were screened out, 7.5% were priority 1, 10.4% were priority 2, and 33 0.1% were priority 3. The priority ranking system says that in priority 1 cases, the child may be in imminent danger, while in priority 3 cases, the allegations or incidents post a low risk of harm to the child.

    Once hotline staff assigns the allegation with a priority level, the case is referred to a local regional office where it is assigned to a case manager, whose duty it is to thoroughly investigate any allegations of child abuse or neglect to ensure the safety of the children involved, the report states. In 4% of the cases reviewed, the auditor found that the case manager did not make contact with the victim within the required days to initiate the investigation.

    Priority 2 cases are supposed to be initiated within two business days, and priority 3 within three business days. The audit report states that in three cases, they found it took:

    • Eight days to make contact with the child victim in a priority 2 case
    • 11 days to make contact with a child victim in a priority 3 case
    • 24 days to make contact with a child victim in a priority 3 case

    This finding was one that was a repeat finding, as previous audits only looked at priority 1 cases, while this audit included all priority levels.

    While the findings of the audit were unsettling, DCS seems receptive to correcting the issues under the guidance of the Comptroller’s Office through their statements of steps taken to correct issues. Additionally, the Assistant Commissioner of Child Programs shared a graphic included in the report showing that nine transitional house locations are under construction in addition to the 15 existing locations throughout the state.