Where is our firetruck? Elevating the value of human services and strengthening workforce development
US human services agencies struggle to recruit and retain human services staff amid intense competition and due to administrative burdens, low pay, and lack of collaboration.
Smoke rises from a burning building—the blare of sirens approaches. Red firetrucks arrive. Firefighters jump out to combat the flames to save precious lives. The community applauds them, and rightly so. They respond bravely to crises every day. Their work is visible, and their contribution obvious to all.
Every day, first responders of another kind work on the frontlines to provide essential support to communities across America. They, too, are brave, but their contribution is far less visible. They include school counselors supporting at-risk youth, parole officers rehabilitating inmates for a return to society, social workers ensuring homes for children without families, home-care workers keeping our aging loved ones independent in their homes, and psychologists treating people who have mental illness or are suffering from substance abuse. These responders comprise a community’s human services workforce, ensuring the health, well-being, and survival of the most vulnerable in society.
“Human services workers are as essential to a strong community as emergency responders, but their contribution is under-recognized,” says Dr. Bill Hazel, senior deputy executive director of the Claude Moore Charitable Foundation and former Virginia Secretary of Health and Human Resources. “They need the equivalent of their own red firetruck as an emblem of their importance to our communities,” observes Lesley Abashian, human services director for the City of Fairfax and president of the Virginia Association of Local Human Services Officers.1
Human services workers in state and local governments encompass a range of functions and expertise, varying from state to state. But they share important commonalities. Often, they are the ones who provide crucial care in the most acute moments of crisis in an individual’s or a family’s life. They can make the difference between a positive trajectory and a negative spiral. Their involvement can provide the missing element that turns a situation around in a child’s life or spurs a drug user’s recovery.
Demand for human services workers continues to grow. National employment of behavioral health professionals by governmental and nongovernmental entities is projected to rise by 18%, from 388,200 in 2022 to 459,600 in 2032.2 Meanwhile, ongoing needs of other populations served by human services workers continue apace, including care for individuals with disabilities, justice-involved, and the financially vulnerable.
Yet, this vital workforce that responds to others’ crises is itself in crisis. The average national caregiver turnover rate is 65%, and the staffing shortages of government human services workers are reaching emergency levels in many communities.3
We have never had the number of ‘job abandonments,’ or unplanned separations, as we do now.
Why has this essential workforce reached such a critical juncture? In short, workers in the field are historically overworked and underpaid, and recent developments have made their livelihoods much less tenable.4 Although many enter the field with a strong sense of mission, it becomes difficult for them to withstand the obstacles that come their way. Their salaries tend not to keep up with the rising cost of living. The pressure of working with populations under stress has grown in recent years, along with an uptick in violence against human services workers.5 As their colleagues leave, the remaining workers are often tasked with taking on even heavier loads. Meanwhile, competing job opportunities at private organizations or other fields tend to offer higher pay, better work conditions, or both. Jobs in the retail sector, for example, pay on par with many human services jobs but entail fewer psychological and physical demands and a lower risk of burnout.
The Claude Moore Charitable Foundation studied the challenges affecting the human services workforce (see nearby inset) and identified solutions to elevate their improvement and development in the Commonwealth of Virginia.6 With Virginia as a prime case study, the findings of “Virginia’s human services workforce strategic investment initiatives report, August 19, 2022” provide a road map for other communities nationwide to build a stronger, more sustainable human services workforce to meet growing needs.
The study’s findings contain strategic options and recommendations across six key stakeholder groups that can affect change in the human services workforce. They include a state’s executive office, state legislators, state agencies, employers, regulators, and philanthropists. The recommendations identify the strategies needed to strengthen the resources, recruitment, retention, and regulation affecting human services.
The job is starting to feel impossible, and it is hard for workers to feel job satisfaction.
The human services workforce in state and local governments may not have a red firetruck as a visible reminder of its importance, but its role in strengthening the social fabric cannot be understated. The growing crisis among these essential workers is a siren call to the communities that depend on them. At this critical juncture, communities across the country have an opportunity to initiate long-needed reforms to put the human services workforce on a more solid footing so that it, in turn, can continue to serve those in the greatest need in the years to come.
Virginia showcases the challenges
An analysis of the workforce challenges in human services in Virginia offers insights applicable to the rest of the nation. Indeed, many communities across the country will recognize Virginia’s challenges as their own.
The commonwealth is currently facing a severe shortage of human services workers to cater to the needs of its residents. It ranks 37th lowest in the country for the number of psychiatrists, psychologists, licensed social workers, counselors, therapists, and advanced practice nurses specializing in mental health care per population.7
The aging of licensed behavioral health professionals in the state is a significant factor behind the shortage. A large and disproportionate number of them are at or nearing retirement age. Among psychiatrists, 61% are age 55 or older.8 Today, only 14 child and adolescent psychiatrists are available per 100,000 individuals below the age of 18 in the state.9
Meanwhile, the expected demand for community and social service occupations in Virginia is twice the average projected rate for all occupations across the commonwealth.10 Virginia’s local social services departments have an average vacancy rate of 15%, which is more than double the average for jobs in the state overall.11 Yet, the median salary for social and human services assistants is US$32,600, which is more than US$10,000 below Virginia’s median wage.12 Only 40% of Virginia’s workforce has a college degree, but it is a requirement for many human services positions.13
The rural location of much of Virginia creates additional hurdles to the availability and delivery of human services. About one in five Virginians live in communities with limited access to behavioral health professionals, and many of these households lack access to broadband internet and telehealth services.14 Additionally, 3.2 million Virginians live in one of the state’s 93 federally designated Mental Health Professional Shortage Areas.15
The case of Virginia demonstrates that the most obvious challenges confronting state and local governments’ human services involve the recruitment and retention of workers. Low pay, difficult work conditions, and the availability of higher-paying, easier jobs elsewhere are causing a rapid decline in staff members. “We have never had the number of ‘job abandonments,’ or unplanned separations, as we do now,” says one participant in the Claude Moore study. “[New staff] get hired until their training is up, and then they leave for a job paying more for less work,” says another.
Common challenges across communities
Communities across America are experiencing similar challenges in recruiting and retaining a robust human services workforce. In addition to low pay, workplace impediments include administrative burdens, insufficient collaboration between services agencies, and lack of a clear career path. These difficulties can build up to become almost unsurmountable hurdles for many human services workers, which could discourage potential recruits. As one participant in the Claude Moore study observed, “The job is starting to feel impossible, and it is hard for workers to feel job satisfaction.”
Recruitment has never been harder
Leaders report historic levels of workforce vacancies and a more challenging recruiting environment.16 State and local human services agencies are receiving fewer and less qualified applicants than in the past. Persistent low pay and poor working conditions in the sector reflect the lack of recognition of the value that human services workers provide their communities. At a time when private agencies and employers outside the sector are eager to hire at higher wages with modern benefit packages, better work conditions, or both, potential candidates often choose to go elsewhere.
The many factors that make retention a challenge
In addition to low pay and the availability of competing employment opportunities, human services workers often face unique hurdles specific to their profession. Social workers often deal with heavy workloads, limited budgets, and erratic schedules. As more employees leave the workforce, remaining workers are left to shoulder an even greater burden. In addition, they frequently suffer from secondary trauma through encounters with the direct trauma experienced by their clients. Plus, the prevalence of violence tends to expose them to unsafe situations. The mental and physical toll of the job is a major contributing factor to high incidences of burnout and attrition.
Regulations may hinder talent acquisition
Government and licensing agencies often impose regulations or credential requirements on employees, such as requiring college degrees, to ensure quality of services.17 Many policies may be outdated, requiring regulatory revisions or changes in code.
Though the pay and working conditions for human services workers are not as good as those in other occupations, the hurdles to getting a job in this field are many. The return on investment often just doesn’t add up, especially when considering the length of time it can take to get licensed after finishing school. Many human services positions in government require a college degree and do not consider experience or skills as a substitute, excluding many candidates from the available pool and limiting diversity in the field. Many times there is not a faster path to licensure even if a candidate already holds licensing in good standing in another state. Moreover, the most requested certifications for counselors and social workers are a Licensed Professional Counselor or a Licensed Clinical Social Worker, which require a master’s degree.18
Administrative tasks add to the burden
A much-needed focus on quality has materialized as significant paperwork and reports required by state and federal authorities, resulting in staff spending more time on completing compliance requirements and reports than providing services to individuals. This inadvertently creates an extra layer of burden on an already narrow talent pool and has exacerbated an existing need for additional support staff. With funding from various federal, state, and other sources, workers spend significant time reporting on documentation instead of carrying out their primary caregiving role. Moreover, they often lack access to technology to make case reporting and other requirements more efficient, especially when working in the field.
Lack of educational incentives and effective degrees block career pathways
Creating relationships between employers and educational institutions can provide opportunities for engagement and career progression through all levels of education. By establishing innovative pathways and early career mapping, clearly defined routes for career progression can be created. Career development plans should prioritize the option for advancement in direct care rather than administrative work. Additionally, those in the field need to have a strong understanding of career progression to improve retention rates.
Missed collaboration takes away opportunities for supporting the human services workforce
Integrating with schools, public safety, and other sister agencies is critical to successful outcomes in human services. For instance, a community might be better off if a public safety officer works with a behavioral health specialist to handle a citizen experiencing a mental health crisis rather than resorting immediately to arrest. Yet, the culture of state and government does not always make cross-functional relationships easy. Each agency tends to function separately from the others and is accountable to its own funding sources and regulators.
The path to addressing the crisis: Four key areas for action
Given the challenges facing the sector, combating the crisis in the human services workforce requires action on four fronts: resources, recruitment, retention, and regulation. Working in concert, they bolster the human services workforce, which can improve the quality of and access to care for the community. For example, today, inadequate resources and regulatory requirements hamper the recruitment and retention of talent. Conversely, adequate resource allocations across sectors, regions, and jobs, working hand in hand with improvements in regulatory practices, can spur a reversal in this dynamic.
To start a virtuous cycle, communities can take the following steps to strengthen resources, recruitment, retention, and regulation in the human services sector.
Resources
- Invest in comprehensive studies to assess where funding can be blended, braided, or adjusted to serve communities and providers better. State and federal guidelines set the reimbursement and shared funding models that contribute to the disparity in regional services availability.
- Consider creative regional funding models that include philanthropic and other community employers and organizations to increase funding. Examine ways to blend and braid funding when emergency medical technicians or police officers lean in for social services work, particularly in rural areas where resources are limited.
- Reassess a more appropriate compensation structure to address pay inequities and determine levels for workers according to market value with cost-of-living adjustments, especially in less-resourced jurisdictions where the current funding formula with low match rates causes a struggle to provide adequate pay and resources.
- Invest in resources needed to carry out care responsibilities, including sufficient mobile technology for field workers, modern technology systems in institutions, and data analysis capabilities by providers and government agencies.
Recruit
- Stakeholders can increase the pool of available workers by reaching out to diverse candidates and by educating the public about the importance of human services work. A public education campaign similar to the Army Strong campaign can help to promote understanding and respect for the field.19
- Increase outreach by human services agencies to elementary and middle school students to help inspire candidates earlier when they are starting to form ideas about future careers. Include guidance about certification programs students can attain after secondary school, community college, or other education levels.
Retain
- Provide adequate compensation, prioritize job quality and experience, and establish clear career pathways. Offer professional licensing programs and creative regional funding models to help improve pay and benefits for human services workers.
- Create onboarding and leadership development programs to improve the job experience. Allow for innovative pathways and early career mapping to elevate career progression in clearly established routes.
Regulation
- Reduce regulatory burdens by having state leadership, regulatory bodies, and service delivery agencies identify the regulations that hinder entry into this profession. Engage state and local agencies and providers that manage federal regulatory standards and reporting (in addition to state requirements) to help make decisions with state boards, regulators, and legislators regarding licensing standards for the health services profession.
- Encourage the review of existing rules and consider innovative solutions to ensure that regulations do not arbitrarily exclude or limit qualified workers, such as instituting licensing reciprocity agreements with neighboring states to ensure adequate staffing.
A road map for each change agent
Measures to improve resources, recruitment, retention, and regulation entail efforts by champions across the human services ecosystem. These include the state executive office, regulators, human services employers, legislators and funding agencies, state agencies, and philanthropic and community organizations. Each can contribute according to its unique purview with initiatives that range from the near term to the long term. The following are actions that each of the six key champions can consider taking.
The executive office
In its leadership capacity, the governor’s office is well-positioned to promote as priorities issues of public awareness, funding, interagency collaboration, public awareness, and the technology needs of human services workers. The executive office can help promote a broader understanding of the value of human services workers by launching a public marketing campaign. Elevating the general importance of the sector can also help all other champions accomplish their goals.
To strengthen funding, the executive office can undertake a variety of measures. The governor’s office can find ways to combine disparate sources of funding from philanthropic organizations, grants, insurance, and elsewhere. Additionally, it can bring together business leaders to identify opportunities for mutually beneficial investments in community wellness.
To encourage collaboration between sister agencies, the executive office can incentivize local police to work with human services by ensuring they are reimbursed directly for their contribution and enabling police and human services agencies to share data. The governor’s office can also take the lead in modernizing social agencies’ technology systems to reduce paperwork burdens on workers, support field workers with mobile devices, and improve connectivity for rural staff.
Regulators
Regulators play a significant role in making human services recruitment and retention more viable. With worker shortages across the economy, the human services sector is losing candidates to other fields due to long regulatory approval times.20 To alleviate current challenges in recruitment, regulators may consider lowering barriers to obtaining licensing where appropriate. Measures can include interstate licensure compacts, where a state recognizes the licensing decisions of other neighboring states. Military spouses licensed in prior posts could receive similar reciprocity. To help students enter the field, clinically qualifying and billable college-level internships or state-approved provisional licensure may also be beneficial.
An overhaul of overly restrictive licensing requirements can widen the applicant pool. For example, the qualifying mental health professional designation could be open to graduates even if they have not majored in the field, provided they complete a training course. Candidates could be allowed to fulfill requirements for more senior qualifying mental health professional designations through training. Meanwhile, to overcome another bottleneck, current employees could be paid for the time they take to supervise the licensure process for recruits. The process should allow virtual supervision, and if no personnel from the relevant department is available, supervisors from other departments can be considered.
Employers
Employers can make more immediate changes to attract and retain qualified personnel than other stakeholders, such as legislators and regulators, whose initiatives may take longer to bear results. Employers, including government employers, can make a difference by modernizing their workplaces to prioritize a more supportive, employee-centric culture. Measures include trust-based leadership and more inclusivity with regular staff meetings to develop solutions for workplace challenges. Staff can even work with peers in other agencies to address common issues. Instead of competing for talent, agencies could collaborate on enhancements to improve retention, such as establishing new daycare centers.
Career development with adequate supervision and training is also crucial, starting with an intentional onboarding program. Then, each employee can have a career development plan, including options that allow for progression in direct care rather than into administrative work if they prefer. In addition, employers can reevaluate pay scales to reward employees based on performance and length of service.
Employers can support self-care to mitigate burnout, including offering flexible schedules and accommodating leave requests. Staff and management can identify and implement solutions to safety risks with the help of sister agencies, such as the police, when needed. Internal peer and clinical resources, modeled after public safety, can also provide essential support for stress, trauma, and burnout. Many employers in other fields are dropping degree requirements to attract more candidates to their open positions. Similarly, human services employers may reconsider what degree requirements are necessary for the human services workforce.
Legislators and funding agencies
Legislators can ensure adequate funding for local human services departments. They can also take additional measures to boost the recruitment and retention of human services workers by expanding educational stipend programs beyond foster care and prevention to broader human services careers to expand the pool of candidates. Additionally, they could pass legislation incentivizing local governments to develop student loan repayment programs. State funding supporting supervision for licensing and development would also lower barriers to entry into the profession.
To boost retention, funding to implement differential pay for less desirable shifts would help compensate for some of the hardships undertaken by human services workers. Expanding laws deeming threats of death or bodily injury to health care providers a class 1 misdemeanor—representing more severe crimes, including assault—to cover human services workers would provide needed protections.
State agencies
State agencies control many essential levers that play a crucial role in affecting the well-being of the human services workforce, including pay structure, pipeline development, and improvements in the hiring process. To establish a more rational pay structure, agencies can undertake comprehensive funding and compensation studies to benchmark compensation for state and local human services workers against that of other healthcare professionals and related fields, such as teachers and police in urban and rural areas, both in and out of state. In addition, a study of job classifications can assess the alignment between job duties and skills and the education and experience required. With workforce shortages across the economy, many employers are considering relevant experience instead of degree requirements.
To broaden the pipeline of candidates, agencies can expose middle and high schoolers to opportunities in the field and address obstacles preventing them from participating in paid internships. Collaboration between philanthropic, educational, and other partners can help elevate the human services sector within the education system. In addition, engagement with local workforce development boards can help recruitment through partnerships with local businesses and organizations that also provide skills training for this workforce.
To reduce bottlenecks in recruitment, agencies can assess requirements, such as fingerprint analyses, often cited for delays in the hiring process. Similarly, they can reduce the paperwork required for barrier crimes, such as long outdated driving under the influence citations, which might eliminate otherwise qualified candidates. More generally, fostering a culture of collaboration between licensing boards and providers can help align licensing requirements more realistically to current hiring needs in the profession.
Philanthropic and community organizations
The contributions of philanthropic and community organizations can pay big dividends when employed strategically in the areas of greatest need. Projects can include assessments of the resource needs of regional and local human services providers and the development of databases and tools to support data analysis of the workforce. These organizations are also well-positioned to invest in public awareness and marketing campaigns to elevate the general understanding of the value of human services work. In addition, they can optimize funding for universities to train these workers.
Building a stronger future for human services workers: A call for community support and recognition
Human services workers play a critical role in addressing the many social challenges facing communities today, ranging from assisting families in crisis, to helping older adults and people with disabilities live independently, to providing mental health services. However, they often lack the recognition and support to continue their crucial work. By undertaking reforms to make human services work more viable in the future, they can build the equivalent of a red firetruck for these local heroes to continue serving the most vulnerable in our society.