The Price of Protection: Health Outcomes for Current and Former Child Protection Services Workers

Background: Child Protective Services (CPS) workers are susceptible to workplace safety and health threats. The high stakes, time sensitive nature of the work combined with involuntary clients and unpredictability contribute to health consequences, including poor physical and mental health, stress, distress, sleep problems, and burnout. Related in part to these job conditions, CPS workers experience a turnover rate of 20-40%, far exceeding the ideal rate of 12%. The consequences of CPS work are well-documented. The evolution of these consequences over time is much less clear. The current study used the stressor-strain framework to examine 3.5-year health trajectories of a cohort of newly-hired CPS workers and considered the role of leaving the profession on health outcomes. Through providing a temporal lens to the study of employment and health, this study yields valuable information about the systematic changes over time; occurrence, timing, and ordering of events; changes in health outcomes over time; and associations between job status and health changes.

Methodology: The Florida Study of Professionals for Safe Families (FSPSF) is a longitudinal cohort study that includes CPS workers hired between September 2015 and December 2016 in all agencies throughout the state of Florida. Follow-up data were conducted every 6 months for 3.5 years. Multi-level models of change (i.e., fixed and random effects models) examined physical and emotional health trajectories over data collection as workers adjusted to or left their positions (N = 1,379 individuals; N = 7,481 observations). Self-reported and validated health outcomes included five-point measures on physical and mental health; psychological distress from the World Health Organization’s Composite International Diagnostic Interview; and Cohen et al.’s (1983) perceived stress scale. To measure employment status, we excluded those outside the labor force and considered: those employed in CPS, employed in health and human services (HHS), employed outside CPS/HHS, and not employed. We included relevant time-varying and time-invariant covariates.

Findings: Approximately 15-20% of respondents reported poor health or mental health and 10% reported serious psychological distress. Stress levels were also high. Health somewhat deteriorated over time, particularly for workers who stayed in CPS compared to those who left to HHS or another profession. Multi-level models indicated exiting CPS was protective of health: it was associated with perceiving better physical and mental health and lower levels of distress and stress. CPS workers’ health trajectories were more problematic than their peers who exited to another field and those who exited to unemployment. The health of those who exited to HHS fell between those who stayed in CPS and those who entered another field.

Conclusions and Implications: Compared to available benchmark data, deleterious health outcomes were quick and persistent among CPS workers suggesting that strain is immediate (e.g., at least in the first six months) and long-term (e.g., at least through 3.5 years) for CPS workers. Results underscore the need for agencies to proactively address the toll of CPS work on their employees. Available empirically-supported strategies suggest taking onus for workers’ total health through on-site education, on-site services, and release time for self-care and healthy behaviors.