A Dynamic Theory of Moral Distress in Child Welfare Workers

Abstract

AbstractChild 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.