Frontline BHDDH Caseworkers speak out on workload crisis impacting services for vulnerable Rhode Islanders

"These new hybrid positions combine social work, plan writing, and managing ever-increasing caseloads. I’m currently at 45 cases and climbing," said caseworker Erica MacDougall.

Frontline social caseworkers and casework supervisors with SEIU Local 580 gathered outside the Department of Developmental Disabilities at BHDDH (Behavioral Healthcare, Developmental Disabilities & Hospitals) to raise urgent concerns over unmanageable workloads, their impact on services for individuals with developmental disabilities, and a lack of investment or even a counterproposal to Local 580’s proposal for pay competitive with Massachusetts and Connecticut.

The social workers represented by SEIU Local 580 are negotiating with the state for a fair contract. The state employs 18 caseworkers, and around 4000 Rhode Islanders need services. To adequately meet the need, each caseworker should be capped at managing 35 clients. Their caseload is around 45 clients and climbing, meaning that the state needs many more caseworkers than are presently employed.

“I accepted the social worker position to serve individuals with developmental disabilities,” said Erica MacDougall. “That role is now titled Conflict Free Case Manager (CFCM), which feels like a state experiment. It appears hastily created to meet a decade-old consent decree, which is lacking clear instructions, support, organization, or realistic timelines. This rushed approach led to the first of 19 CFCMs, including me, being hired, starting in August 2024. These new hybrid positions combine social work, plan writing, and managing ever-increasing caseloads. I’m currently at 45 cases and climbing. The job requires managing complex medical and behavioral client needs and monthly monitoring meetings, and while monthly contact is required, many clients need daily or weekly interaction instead.

MacDougall continued:

“This dual role of social worker and plan writer is unprecedented and fundamentally unworkable, making it difficult to provide adequate and thorough care. Adding to this burden, our caseloads lack regionalization. Driving across the state for monthly meetings with 45 clients is extremely time-consuming, requiring multiple distance trips in a single day, separate from all the other case management tasks.”

“Furthermore, creating person-centered plans, also known as PCPs and ISPs (Individual Support Plan), is a significant, time-consuming new responsibility for social workers that plan writers traditionally handled. This process is lengthy, requiring extensive time to understand clients, identify their needs, risks, goals, find providers, gather documentation, draft a legal plan, obtain signatures, and manage ongoing changes. This complex task, combined with the social worker duties, is a demanding, hybrid role difficult to manage effectively.

“In addition to the monthly monitoring, creating the PCPs, which is a historically separate dedicated role, is now a brand new, unmanageable responsibility for the social workers. This task is intensely time-consuming and complex, involving many steps and constant changes, especially as many clients are brand new to BHDDH with no prior state services or prior PCPs. This requires multiple meetings to understand the client’s needs, risks, hopes, and goals for their yearly planning. And beyond understanding the client, it involves identifying and coordinating providers, submitting referrals, gathering extensive documentation, drafting legal PCP abiding documentation, and arranging services such as residential or Service Level Agreement (SLA) supports, which is an intricate part of our social worker position.

“CFCMs at BHDDH regularly face overwhelming, understaffed, and over-assigned situations leading to burnout. We have already lost five of our CFCMs internally and have not even made it a year. We have repeatedly reported these concerns and the resulting record-high turnover rate to BHDDH’s administration, highlighting the negative impact on the clients, particularly those with developmental disabilities who struggle with change more than the general population. However, despite numerous meetings and reports, our concerns receive no resolution or acknowledgement. BHDDH administration has consistently failed to address our requests or suggestions, only offering big promises with no follow-up.”

Matthew Gunnip, SEIU Local 580 President, called on BHDDH leadership “to invest in staffing and retention and to include frontline input in decision-making. Those we serve—individuals with developmental disabilities and their families—deserve efficient, compassionate, and effective services.”

Gunnip noted that despite BHDDH’s claims of limited resources, the fiscal year 2025 transparency portal lists 108 positions titled “Admin,” “Manager,” or “Director,” suggesting resources are available but poorly prioritized.

“Unfortunately,” said State Representative David Morales, attending the press conference in support of the frontline BHDDH workers, “we have a state that often overlooks and undervalues behavioral health. That toxic culture has allowed administrators to not take action to meet the needs of their frontline caseworkers who are doing the work, day in and day out, to serve Rhode Islanders in need. The end result is that people have to suffer.

Representative Morales continued:

“Clients and their families are suffering, and our frontline caseworkers are being burned out, having to continuously take on higher caseloads, and quite frankly, work environments that are just plain stressful. While I’ve been proud of our work in the legislature over the last several years to increase budget investments for BHDDH, the reality is that despite these investments being made, action from the administrators to fill vacancies has not been taken.

“Instead, we have watched as vacancies continue to sit around despite the money being there. We have watched as directors and administrators receive bonuses and annual salary increases, while frontline workers receive far from a living wage.”

Steve Ahlquist: What happens when these allocated funds are not spent?

Representative Morales: We are watching as departments do not fill vacancies despite having the funding, and then the following fiscal year, the governor's office comes out with a press release saying we have a budget surplus, when oftentimes that's just money that was not otherwise spent to fill these vacancies and ensure that we have safe staffing levels.

Matthew Gunnip, President, SEIU Local 580: Picking up on that... it feels like the legislature allocates money and positions that are intentionally not filled at DHS and DCYF, and it seems like that also happens at BHDDH.

Caseworker Alex Blue expressed concerns as well:

“The EOHHS and BHDDH administrations have become so focused on implementing regulations that they have lost sight of the individuals and communities these regulations are meant to serve,” said Blue. “The intent behind case management is to provide self-determined supports, to be person-centered, and to empower those we work with. Yet, when we emphasize numbers and compliance, we forget empathy. We forget that the people we work with are exactly that - people. We amplify systems that stifle people with disabilities, systems that promote stagnancy in their lives, while the constant change from high worker turnover rates leaves everyone discouraged. We all suffer when we lose empathy. Accessibility empowers all, but when we overwork frontline workers, we deny people the future they deserve. The administration averts its eyes from any issue that is not an acute crisis.”

Blue continued:

“I am not here to assign blame. Focusing on acute crises is very human, yet we have a chronic hum of injustice and dissatisfaction that must be addressed, and as frontline workers, we feel that need and we have the power to help address it - that is, we would if we were allotted the time, energy, and resources to do so. Instead, we are bombarded with a numbers game.

“How many people can you witness the system failing before you break down and burn out? We are not here today to request easier jobs. We are here to fight for a future of empathy, accessibility, and empowerment. As frontline workers, we will not sit back and watch the individuals and communities we work with be whittled down to numbers, rules, and regulations. We will remember the intent behind these regulations and will not cease to advocate for a world in which we can be there for our individuals and communities when they need and want it.

“Our system is money-centered, regardless of how much lip service we pay to being person-centered. As workers, Rhode Islanders, siblings, parents, friends, or loved ones, we refuse to forget the individuals at the heart of our roles.”

“Social work and behavioral health are essential work,” continued Representative Morales. “That’s how we keep our communities healthy. That is how we take care of one another in our state, especially those who have been referred to the state for services. By failing to meet that obligation, we are hurting families, patients, and workers, as well as the future of our state.

“I’m calling on the administration of Governor McKee and our department directors to take on this next fiscal year with urgency. Recognize that you have the funding necessary to ensure we no longer have frontline vacancies. We have an opportunity to expand access for more full-time employees who can take on the continuously growing caseloads. With the available money and a collective bargaining unit prepared to negotiate in good faith, there is no excuse that we can’t take care of our most vulnerable Rhode Islanders.”

Here’s the press conference video: