Have you ever tried to fit a square peg in a round hole? This is what in-home counseling sometimes feels like.

Picture this:

You walk into work ready to manage your team of dedicated, do-good counselors who have (among the 4 of them) about a dozen in-home family therapy sessions to complete today for their clients. Your calendar is up-to-date, color-coded, and peppered with blank spaces yet to be filled with interruptions. A few meetings here, some paperwork there. Things should be pretty manageable today.

Then reality kicks in.

At 9:10am, your senior staff, Kayla, calls out sick. She visited a flu-ridden home yesterday to meet with a 13 year-old who self-harms on the daily and isn’t yet ready to talk to her dad about it. Kayla had three in-home sessions scheduled for today (in 3 different cities) and now you need to find coverage from other staff who have full plates of their own.

In this field, sometimes it feels like asking for a kidney when it comes to asking someone to add an hour or two to their already 10-hour work day.

Kayla feels terrible about calling out – she tells you this – but you must assure her (textbook style) that This is what sick days are for. The team will pick up the slack like always. You manage to cover two of her three sessions (you do one, since everyone else is booked), and the third client says they’ll manage with a phone call, which you end up doing to save some time for everyone else.

Later in the morning you finish up some paperwork, emails, phone calls, and meet with a new hire to prepare for his first in-home family therapy session. Of course, a call comes in from another staff – and she sounds a bit frantic.

“Becky attacked mom!” she cries. You ask the right questions: What was the trigger? Is mom okay? Where is Becky now? and send the staff straight to the family’s apartment to make a safety plan with them as soon as possible.

The staff calls again while on the road five minutes later, spiraling with concerns about working too many hours today (Becky wasn’t on the schedule), and a 20-minute conversation ensues on how to address the crisis, handle her packed schedule, attend a lengthy team consult, and complete documentation notes by a reasonable hour.

Could you cover session #3 for her, an hour away from the office? The question enters both of your minds, but your ears ring with a mantra from your own manager: “Do not rescue them!” This sentiment, of course, comes from the humble place of self-preservation. Yes, I do care, you remind yourself as you push back down the thought to offer your time.

It’s 1:30pm now, and you’re scarfing down a peanut butter sandwich while answering emails from state protective service workers. It’s truly a skill to coordinate a team meeting for eight people while playing Tetris with staff’s calendars. You had to cancel your own development meeting with your manager due to covering a session this afternoon, and you’re still feeling a bit uneasy about missing some key points during the new hire’s training this morning.

There is only time for doing – not teaching – and so you send your new hire half-equipped to his first family therapy session. At least he can call you if anything goes awry.

It’s 4:00pm and you’re so close to making it through the day. Surprise! An emergency admission mandate flashes on your email: the family needs to be admitted to counseling this evening due to safety concerns. The email is (of course) addressed to bed-ridden Kayla. You spend the next hour scheduling with the family, prepping paperwork for the admission session, and fielding calls from other staff.

You attend the admission session by yourself tonight. It ends at about 7:30pm, because Johnny’s mom needs to tell you about how she feels disrespected by him, and you need to listen. It’s a delicate balance of empathy and keeping a healthy emotional distance upon first meeting someone you’ve been deployed to support.

Alas, the day is done (unless you’re on call, but that’s another story).


Where do we go from here?

In the profession of supporting youth who are at risk of being removed from their homes, unpredictability is the only constant. Despite solving a handful of problems today on the fly (conducting two therapy sessions, reassuring and teaching staff, and staying on top of paperwork), the weight of the stress has completely outweighed the satisfaction you might feel for completing any one of those tasks alone.

And don’t forget, some of your staff had an even more stressful day than you. After all – they met with families experiencing serious relational conflict. They grappled about pervasive systemic conditions that led them here. They asserted themselves in spaces where they may have not been wanted nor trusted, because that’s their job, and that’s unfortunately how the system works today.

It’s days like these that make you re-evaluate why you’re here. What gives? 🤔

This example is pretty accurate to daily reality when it comes to the workings of in-home clinical social work. In a system so heavily constrained by lack of funding and frequent turnover, the time feels critical to seek alternative strategies to keep these very important jobs afloat. And for social workers who genuinely want to help people – why wouldn’t we help them?

In surveying the peaks and valleys of the social work system, we need to start with broad ideas for improvement before working our way towards deeper solutions. The issues at hand are many, and they are complex. And it takes buy-in to make real change within such emotionally taxing work.

During my time as a manager I’ve learned that tending to the well-being of staff is the most critical move to extend ripples of relief to the people they support. Here are ideas for making some initial positive ripples in a social services system that is (at this rate) at risk for collapse:

1. Engage, engage, engage

Who wants to feel burnt-out and unappreciated? Leaders need to focus on action steps to help their staff feel valued, appropriately challenged, and trustful of their peers and managers. Taking time to learn about the dynamics of effective teams is worthwhile when staff depend on one another for just about everything. In a nutshell, some key things to keep at the forefront are:

  • Psychological safety: create spaces where people perceive they can take interpersonal risks, float ideas freely, and make mistakes among others who respond supportively. This is the big-ticket item in any well-functioning community (work, school, home, neighborhood, teams, etc.).

  • Structure and clarity: clarify job expectations, the process for fulfilling these expectations, and the rewards/consequences for staff performance. The clearer, the better.

  • Meaning: support people in finding a sense of purpose in the work (or the output). The meaning of work is personal, and includes things like financial stability, helping others, supporting a family, or expressing oneself.

  • Impact: help people see how their work contributes to the organization’s bigger picture goals. Especially the challenging work.

2. Quality over quantity

True, giving staff a caseload of 5 families instead of 4 will bring in more money from funders, but it will significantly increase the likelihood of good workers leaving the field to preserve their sanity and work-life balance. Domino effects occur when remaining workers bear the brunt of leavers – leaving those 5 families with lower-quality support that just scrapes the surface of adequate care.

Talk with workers about what is truly reasonable in terms of making impact, and consider how money earned now may affect money (and good workers) lost later. Collect the data, and share it with the decision makers.

3. Invest in wellness

Identify the emotional paper cuts this field can open and cater staff development to those needs. Do staff need a refresher on vicarious trauma? Will they benefit from dedicated time to share ideas on how they combat stress? Time spent on preventative care can make all the difference when it comes to facing a stressor head-on, not to mention increase their own problem-solving skills.

4. Expand resources (creatively)

Let’s be honest – it’s hard to buy items for a youth’s sensory toolbox on a $10 budget. Brainstorm creative ways to get the ideas and materials you need. Is the art store open to giving a discount on surplus items? Is the local university willing to donate tickets to their basketball games, to give youth and parents some quality-time resources? You never know what you might get until you ask.

5. Take productive risks

Will hiring someone to do filler-work (when someone is out sick, session coverage is needed, or that audit has to get done) benefit workers and systems overall? Where can we cut back funding to invest in something that will really quench the thirst of frontline staff? What are they asking for that’s reasonable and helpful? You can’t put a Band-Aid on a burn and expect everything to be okay.

Each of these ideas scratches the surface of strategies that might make days in the helping profession a bit easier. They are certainly not easy fixes – especially coupled with emotionally taxing work that permeates people’s mental clarity, making it hard to catch a balcony view.


It’s clear that the majority of people pursue type of work because they care, and because they truly want to ease the sufferings and inequities that come with involvement in the social service system. It’s imperfect and will remain imperfect. But I believe the profession of social work deserves a continual evaluation, one where we can’t accept the daily status quo, simply because it’s an area that needs quality workers who must give up much of themselves for a larger ideal.

My decision to leave in-home counseling work was complex, and it involved weighing the gains and losses of sacrificing pieces of my own well-being for a perceived greater good. It’s noteworthy, though, to say that the job that burned me out also left me with the most resilience.

Even if you’re not managing a team of in-home counselors, the take home message should be clear. We will find brilliant and empathetic people in every crevice of social work. The work they do is under-resourced, taxing, and essential, and they will keep doing it until they can do it no longer. When everyone’s end goal is to better support the vulnerable in our society – how could we not start at the source?