A Dynamic Theory of Moral Distress in Child Welfare Workers

Abstract

Child welfare (CW) professionals who provide direct services to families, referred to as ‘caseworkers’ in the USA, often have to act in ways that are inconsistent with their professional values, leading to feelings of guilt, anxiety and self-blame, referred to as moral distress. The conceptual basis for moral distress primarily comes from the nursing literature, leaving a theoretical gap in how CW workers experience moral distress. Hence, this study used qualitative system dynamics modelling to develop a dynamic theory of moral distress amongst US CW caseworkers (N = 25 focus groups, 192 participants). Results, presented in a qualitative system dynamics model, reveal that participants held strong values pertaining to CW casework and that moral distress was common. Participants described discrepancies between the services they wanted to provide and the services they were actually providing, and the distressing feelings that resulted. Study findings also highlight coping strategies and ‘breaking points’ related to moral distress. Overall, this study’s dynamic theory provides a framework that illustrates the stock (accumulation) and flow (release) of moral distress specific to CW caseworkers and sheds light on the psychological distress and conflict experienced in this profession. Implications for social work education and CW organizational change are discussed.

“How About Being Trustworthy Rather Than Asking Families to Trust?”: A Prerequisite for Child Protection Authorities Partnering with Indigenous Communities

“…We do well to recall the survey respondent who considered that the system made child protection workers operate contrary to how they preferred to operate. The literature tends to support this view (Krumer-Nevo, 2020;Lonne et al, 2013;Marsh et al, 2015;Stahlschmidt et al, 2022). Through supporting and learning new child protection practices from Aboriginal third parties, the beliefs underpinning the edifice of child protection may be challenged sufficiently to make way for a relational care ethic to take hold to benefit everyone.…”

Physiological evidence of escalating stress during COVID-19: a longitudinal assessment of child welfare workers

“…Child welfare workers regularly work around the clock and for agencies that often face difficulties in obtaining resources (Beer, Phillips, Letson, & Wolf, 2021;Kim, Ji, & Kao, 2011). Also, research has identified that case severity, public perception, moral distress, and amount of time needed to spend with clients all contribute to stress (Kothari et al, 2021;Lawrence, Zeitlin, Auerbach, Chakravarty, & Rienks, 2018;Stahlschmidt, He, & Lizano, 2021;Zeitlin, Chakravarty, Lawrence, & DeCristofano, 2019). While the body of the literature examining factors that contribute to stress in child welfare is robust, a meta-analysis by Kim and Kao (2014) categorized all relevant factors leading to turnover into four domains including demographic predictors, work-related predictors, work environment, and attitudes/perceptions.…”