OP-ED: Triage Isn’t Care

By Cairo Brown

Youth holding a trash bag of belongings while adults gather in the background, illustrating strain in Philadelphia’s child welfare system.

A child welfare system is only as strong as its workers.

There is a crisis unfolding within Philadelphia’s child welfare system, and it’s not just a bureaucratic failure; it’s largely a human one. Philadelphia’s Community Umbrella Agencies (CUAs)—these private nonprofits responsible for managing almost all of Philadelphia’s foster cases—are buckling under the weight of unsustainable caseloads, leading to brutal burnout and preventable gaps in care that are a direct result of the exhaustion and overworking that these workers experience. If Philadelphia wants to protect children, it must eliminate these failings. To eliminate these failings, the city must first protect its workers.

The foundation of the child welfare system lies on the relationship built between caseworkers and their clients. Caseworkers must be trusted and valued by the families they help (and vice versa) in order for government intervention to bear fruit. It requires time, it requires presence, and it requires—most importantly, in fact—mental and emotional bandwidth. This isn’t achievable with Philadelphia’s current system, though. This stems from a very simple problem: the way Philadelphia’s DHS answers the question, “What is a case?”

Doing the Math

In most other parts of the state, one case equals one child. This isn’t the case in Philadelphia, however. Here, one case equals one family, regardless of how many children are actually involved. A family of ten is expected to be cared for in the exact same way and in the exact same timeframe as a single mother and an only child. There is a statewide limit of thirty cases for caseworkers, meaning caseworkers could be overseeing fifty, sixty, or perhaps even more children. Luckily, in Philadelphia, things have not quite reached this level, but many caseworkers report caring for nearly twenty kids at a time, which is still far too many to administer a proper standard of care.

When one person is responsible for caring for, cataloguing, interviewing, documenting, and building relationships with twenty to sixty children, Philadelphia’s child welfare status quo suddenly begins to sound like a pipe dream. It’s no longer care; caseworkers call it “triage,” a word for sorting urgent needs when there are not enough resources to meet them all. Deadlines, workloads, and great expectations push caseworkers from being carergivers into pencil pushers. They divert some children to this program, offer aid to that one, do a random house search for this family, but there’s no opportunity to truly hunker down and look at the details. The minutiae of these cases need to be known to provide care, but they can only be learned over time.

This often places an unbearable physical and emotional toll on workers, with some Philly CUAs seeing turnover rates upward of forty percent each year. When one caseworker barely making $40,000 a year burns out and quits, then the remaining caseworkers must take on that individual’s cases, potentially adding dozens more kids to an already hefty load, and pushing others that much closer to their breaking point.

The Real Price

But the ones who truly feel this are the children. Every time a caseworker quits, a child may lose the only person they trusted, the person who knew their history, their needs, and their progress toward reuniting with their family. New caseworkers start from scratch; they rebuild relationships, relearn stories, and everything in the process takes longer because of it. Improving worker salaries and enforcing a strict caseload cap is the first step to fixing this broken system.

A widespread standard of care must also be enforced. Each CUA is its own private, individually run institution with its own rules, standards, and resources. The quality of care a child will receive can vary widely based just on their zip code. The city needs to implement a standardized, fully-funded model that ensures every caseworker can do their job to the absolute best of their ability.

This means hiring more workers with better salaries so that caseloads remain manageable, and employing administrative staff to handle a portion of the mundane paperwork that keeps caseworkers from the children they’re meant to help.

People may point at the cost of all of this and say it will cost taxpayers far too much, but it’s costing just as much, if not more, to keep children languishing in group homes, or with foster families receiving weekly stipends, instead of helping families to properly reunite. More important than the monetary expense, though, is the human cost when a child slips through the cracks, or a foster placement fails. This shouldn’t be a price we’re willing to pay.

One thing is made clear here: the city is asking people to do the impossible, and then being surprised over and over when it isn’t achieved. To better care for children and families, we must better care for the people providing that care. With real effort to stabilize the workforce, triage can become care again. It’s time to start treating caseworkers not as expendable labor, but as the lifeline for children and families that they are.

Cairo Brown is a student at Central High School and lifelong resident of northwest Philadelphia.


📚 Keep Reading, Keep Asking |  Want to better understand what’s happening in Philly’s child welfare system? Start with Children First, Juvenile Law Center, and the Support Center for Child Advocates. Then tell us what you think:

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