Iowa Ideas
Iowa Ideas

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Why Iowa should invest in its human services workforce

Aug 29, 2019 at 9:30 am
    John Twardos is president and chief executive officer of Lutheran Services in Iowa. (Submitted photo)

    Iowans’ Ideas: Guest columns featuring the views of different Iowans in each edition of Iowa Ideas magazine.

    By John Twardos

    Iowa must invest in its human services workforce.

    At Lutheran Services in Iowa, we believe Iowa truly will be a better place when we invest in the people whom society often chooses not to hear — children in the juvenile justice and child welfare systems, people with disabilities, people who have come to Iowa as refugees or immigrants, families struggling with mental illness or substance abuse.

    An important way to support better outcomes for our fellow Iowans is to invest in a strong and stable human services workforce. Lutheran Services in Iowa employs hundreds of social workers, therapists, nurses and direct-care professionals across the state. As one of the largest and oldest human services agencies in Iowa, Lutheran Services affects thousands of children and adults each year through child-abuse prevention, foster care and adoption services, services to families and youth in crisis, services for people with disabilities, and empowerment programs for refugees and immigrants.

    But many Iowa agencies, Lutheran Services included, face an increasing strain on our workforce. There are several factors at play here, including Iowa’s low unemployment rate, ongoing challenges with Iowa’s Medicaid managed care environment and the unwillingness of state lawmakers to increase reimbursement rates for critical services for children and families.

    The low unemployment rate hits human services agencies particularly hard. Unlike a for-profit coffee shop that can increase the cost of a drink a few cents when labor or overhead expenses rise, most of the services we provide are reimbursed at static rates by the state of Iowa or one of Iowa’s managed-care organizations, or MCOs, the private companies that oversee Iowa’s Medicaid system. Those reimbursements have remained largely stagnant for years and do not keep pace with the cost of doing business.

    The managed-care environment has placed unprecedented pressures on not-for-profit human services agencies. As with many of our sister organizations, Lutheran Services has struggled to collect hundreds of thousands of dollars owed to us by the MCOs.

    Together, these factors make it difficult to pay our workforce what it deserves. Social workers spend long hours doing intense work to help Iowa families succeed. Many social workers play a vital role caring for children and families. Many face caregiver burnout while going for years at a time with no pay raises.

    In residential treatment centers in Iowa, direct-care workers with four-year degrees make an average of just $28,888 per year, according to the Coalition for Family and Children’s Services in Iowa. These are college graduates who work with children and teens who’ve experienced profound trauma and, as a result, have extremely complex mental and behavioral health challenges.

    Our reimbursement rates remain low despite the growing need for the services we offer. Many of our programs have waiting lists. One in five Iowa children has or will have a mental illness. There has been a 44 percent increase in the number of kids living in poverty in Iowa from 2000 to 2016. In 2017, 2,596 kids entered foster care in Iowa.

    The number of founded child-abuse cases is on the rise. From 2014 to 2017, confirmed child abuse cases increased by 13 percent.

    In that same time period, state funding to child welfare services across the state dropped by 4 percent.

    If you are a parent, a grandparent, an Iowan, a human being — these statistics should concern you. These are our children, our neighbors. These tragic numbers should alarm us all — especially our policymakers.

    But it’s not all gloom and doom. At this moment, we have a window of opportunity to begin to turn the tide on generations of underfunded human services. Here’s why I’m hopeful:

    Iowa is preparing for the federal Family First Prevention Services Act (Family First) to take effect in July 2020. This federal legislation dramatically will impact the delivery of human services in our state, focusing on keeping children safely in their homes and prioritizing preventive services for substance use, mental health services, and parenting education. This should lead to fewer children needing out-of-home placements, and shorter stays for children in group homes and shelters.

    It’s a good thing; but just like the new children’s mental health state system, it must be funded adequately so providers can retain qualified workers.

    This is a key opportunity for Iowa’s leaders to rethink how they value their human services workforce — from direct-care staff to psychiatrists. Our lawmakers should create workforce initiatives that attract and reward human services employees that hold the MCOs accountable to good business practice, and that reimburse providers at rates that make it possible to continue to empower excellent outcomes for struggling families.

    This will require a significant financial investment, and it’s one we will continue to demand from our elected officials during the 2020 legislative session. You can sign up for advocacy updates and learn more about each of these issues at

    Iowa’s children and families — and the people who support them during their most difficult moments — should not suffer the consequences of inadequate funding.

    • John Twardos is president and chief executive officer of Lutheran Services in Iowa.

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