Caseload Size Research Articles

Medicaid and Supervision in Schools

Medicaid and Supervision in Schools

Treating traumatized OEF/OIF veterans: How does trauma treatment affect the clinician?

The authors of this article describe the rewards and challenges for clinicians treating veterans who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Issues of vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout are defined and reviewed, as are compassion satisfaction and posttraumatic growth. Patient, clinician, and organizational characteristics that are likely to affect clinicians working with this clinical population are discussed. Patient factors that may increase strain on clinicians are discussed such as age, likelihood of redeployment, comorbid conditions, attendance issues, and elevated risk for suicide and aggression. Clinician factors, such as theoretical orientation, training, supervision, military affiliation, personal trauma history, spirituality, social support, and self-care, are also discussed as possible risk and protective factors for vicarious trauma and burnout. Organizational influences, such as caseload size and diversity, clinician control and autonomy, use of evidence-based practices, availability of resources, rural isolation, and the philosophy of the clinic, are further discussed. Recommendations for ameliorating risks are discussed relative to each area and include allowing clinicians to plan their own appointments so as to balance their caseload of OEF/OIF veterans, attending to self-care practices, and having a supportive team with thorough training in evidence-based practices. Future empirical research is needed on risk and resiliency factors for clinicians working with traumatized OEF/OIF veterans given that this population is likely to grow.

Analyzing Offense Patterns as a Function of Mental Illness to Test the Criminalization Hypothesis

Analyzing Offense Patterns as a Function of Mental Illness to Test the Criminalization Hypothesis

Health Care Provider Perceptions of Pain Treatment in Hispanic Patients

Despite increasing numbers of Hispanic patients in the United States, this group continues to face disparities in access and quality of pain treatment. Although previous surveys have examined treatment disparities experienced by minority patients, none have provided a provider-centric perspective on issues and concerns surrounding pain relief among pain patients of Hispanic/Latino origin. The goal of this study was to assess the relationship between provider characteristics (ie, Spanish fluency, Hispanic caseload size, and experience with Hispanic pain patients) and their perceptions of pain treatment in these patients. One hundred eighty-seven health professionals completed an online survey. The major findings indicated that: (1) less than 20% of health professionals treating Hispanic pain patients reported Spanish proficiency at an advanced level; (2) surveyed health professionals were involved treating a significant proportion of Hispanic patients in their caseloads, but reported a lack of cultural competence training; (3) Spanish fluency and experience with Hispanic pain patients exerts a strong effect on the use of established pain treatment practices; (4) providers with greater Spanish fluency report a significantly greater effect of patients' cultural beliefs and attitudes on treatment; and (5) providers did not regard cultural or language barriers as significantly impacting opioid prescribing or patient compliance.

Testing Probation Outcomes in an Evidence-Based Practice Setting: Reduced Caseload Size and Intensive Supervision Effectiveness

Probation and parole professionals argue that supervision outcomes would improve if caseloads were reduced below commonly achieved standards. Criminal justice researchers are skeptical because random assignment and strong observation studies have failed to show that criminal recidivism falls with reductions in caseload sizes. One explanation is that caseload reduction by itself is insufficient; supervision must also be allotted and distributed to make the best use of supervision resources, a cornerstone of evidence-based practice (EBP). This study uses a regression discontinuity design (RDD) to test the null hypothesis that reduced caseload in an agency using EBP has no effect on criminal recidivism. Our conclusions are that reduced caseloads in this context probably reduce criminal recidivism and probably do not increase revocations for technical violations.

Professionals' Perspectives on Organizational Factors That Support or Hinder the Successful Implementation of Family-Centered Practice

This article presents findings from an exploratory, qualitative study whose objective was to identify professionals' perceptions of organizational factors that support or hinder the implementation of family-centered practice (FCP). Two disability services organizations in Manitoba, Canada, were selected as the research sites. In 2002, all staff were invited to participate in qualitative interviews and focus groups, resulting in 36 people responding (front-line service coordinators, supervisors, and key informants). The analysis identified factors related to the organization's culture and climate (such as caseload size and activity, supervision, and training), policy limitations, and collateral services, as negatively affecting the ability to successfully implement FCP. The findings suggest that organizations should develop and maintain organizational cultures and climates necessary to support, implement and sustain FCP to positively impact service quality and outcomes.

Effects of Universal Newborn Hearing Screening on an Early Intervention Program for Children with Hearing Loss, Birth to 3 Yr of Age

Universal Newborn Hearing Screening (UNHS) was introduced in Kansas in 1999. Prior to UNHS a small percentage of newborns were screened for and identified with hearing loss. The purpose of this study was to determine the effects of UNHS on a local early intervention (EI) program for young children with hearing loss. This was a retrospective study based on the chart review of children enrolled in the EI program during target years before and after the establishment of UNHS. Charts for 145 children were reviewed. The chart review targeted the following aspects of the EI program: caseload size, percentage of caseload identified by UNHS, age of diagnosis, age of enrollment in EI, degree of hearing loss, etiology of hearing loss, late onset of hearing loss, age of hearing aid fit, percentage of children fit with hearing aids by 6 mo, percentage of children with profound hearing loss with cochlear implants, and percentage of children with additional disabilities. Changes in the EI program that occurred after UNHS were increases in caseload size, percentage of caseload identified by UNHS, percentage of children fit with hearing aids by 6 mo of age, and percentage of children with profound hearing loss with cochlear implants. There were decreases in age of diagnosis, age of enrollment in EI, and age of hearing aid fit. Before UNHS, the majority of children had severe and profound hearing loss; after UNHS there were more children with mild and moderate hearing loss. The percentage of known etiology and late-onset hearing loss was approximately the same before and after UNHS, as was the percentage of children with additional disabilities. UNHS had a positive impact on caseload size, age of diagnosis, age of enrollment in EI, and age of hearing aid fit. The percentage of the caseload identified in the newborn period was about 25% before UNHS and over 80% after its implementation. After UNHS, the EI caseload included as many children with mild and moderate hearing loss as with severe and profound loss. By the last reporting year in the study (academic year 2005-2006) all children with profound hearing losses had cochlear implants.

Case Management for Long-Term Conditions: Developing Targeting Processes

Intensive case management (ICM) is traditionally targeted at patients with complex needs and exists within a wider service context. Targeting is integral to the efficiency of the service. A process and outcome evaluation of case management was conducted in a large urban area in England between 2007 and 2008. Data from a postal questionnaire, interviews, and resource utilization data of patients within the service are used to explore issues associated with targeting. The study identified various approaches to select appropriate patients. A lack of standardization in assessment was apparent. Reported policies on case allocation, caseload size, and frequency of visiting patients varied. There was little evidence of ICM. Not all patients in receipt of case management admitted to hospital were diagnosed with a specific disease or condition. Few patients were recorded as discharged and transferred to another service. We conclude that measures of targeting often focus only on admission to a service and specific outcomes and suggest that targeting be considered as a series of interconnected processes rather than static indicators.

What Makes a Caseload (Un)Manageable? School-Based Speech-Language Pathologists Speak

Large caseload sizes and a shortage of speech-language pathologists (SLPs) are ongoing concerns in the field of speech and language. This study was conducted to identify current mean caseload size for school-based SLPs, a threshold at which caseload size begins to be perceived as unmanageable, and variables contributing to school-based SLPs' feelings of caseload manageability. Approximately 2,000 public-school-based SLPs from across the country were solicited to participate in an online, Web-based survey between April and May of 2007. Of those SLPs who were contacted, 634 full-time SLPs from 49 states completed the survey. The data were evaluated using descriptive statistics and logistic regression. The mean caseload size for SLPs in this study was 49 students. At the caseload range of 41-50 students, approximately 60% of the SLPs perceived their caseload size as unmanageable. Logistic regression revealed caseload size, years of experience, and extent of collaboration as significant predictors of an SLP's likelihood of feeling that his or her caseload size is manageable. Caseload size continues to be an area of concern for school-based SLPs, and efforts to address this problem must continue in order to prevent long-term struggles with SLPs' dissatisfaction, shortages, and turnover. Policy, research, and clinical implications are discussed.

An Analysis of Factors Shaping Interventions Used by School Social Workers

This study is a secondary analysis of surveys collected from school social workers in Illinois. Workers were originally surveyed about the most important student problems they confront in their schools and their preferred targets of intervention (individual, small group, family) to address those problems. Drawing on related conceptual work, the current study tested the utility of a preliminary model of factors that are hypothesized to influence school social work practice, taking in characteristics of the practitioner, characteristics of the setting, and sociocultural context. School social work practice was measured in terms of both interventions used and interventions used most frequently. Findings revealed that specific factors reflecting characteristics of the practice setting related to school social worker reports of their practice. Specifically, caseload size, grade level of students served, and district size were inversely related to frequent use of individual counseling but positively related to use of group counseling. Implications for school social work research and practice are discussed.

Retention of School-Based SLPs: Relationships Among Caseload Size, Workload Satisfaction, Job Satisfaction, and Best Practice

Nationally, the shortage of speech-language pathologists (SLPs) in the schools is growing. As such, it is important to understand factors related to the retention of SLPs in this setting. This study expanded on previous research by examining a wider range of factors that may be related to the retention of SLPs including caseload size, workload satisfaction, job satisfaction, and time available to conduct best practice. Participants were 75 full-time SLPs working in a school setting in the state of Vermont who completed a survey designed to solicit information concerning the variables of interest. Several dimensions of job satisfaction and best practice predicted retention, caseload, and especially workload. The results also suggested that high workloads complicate the implementation of best practice and have implications for retention. Limitations of the research and implications for practice are discussed.

THE MEDICAL MODEL, MENTAL HEALTH PRACTITIONERS, AND INDIVIDUALS WITH SCHIZOPHRENIA AND THEIR FAMILIES

The medical model is the dominant treatment paradigm in mental health practice. The purpose of this mixed methods study is to explore the influence of the medical model of treatment on individuals with schizophrenia and their families in a large community mental health center. Findings from the quantitative data indicate that nurses (mean 23.58), not social workers, had significantly more clients with schizophrenia on their caseloads and also have the largest caseloads (mean 73.36). Qualitative data from practitioners suggest that the medical model of treatment has an important influence over caseload composition and size. Implications for individuals with schizophrenia and their families as well as for social work are discussed.

Caseload Management, Work-Related Stress and Case Manager Self-Efficacy Among Victorian Mental Health Case Managers

In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services. A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy. The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring. Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy.

Perceptions of Job Stress and Satisfaction Among School-Based SLPs: Challenges Versus Rewards

Abstract This study utilized a survey design to gather information regarding caseload and employment factors affecting school-based speech-language pathologists' (SLP) perceptions of job stress and job satisfaction. Results indicated that respondents experienced relatively low levels of job stress and high levels of job satisfaction. The majority of respondents (95%) reported being somewhat satisfied or very satisfied with their jobs, while only one-third of respondents (35%) reported experiencing serious work problems. With the exception of caseload size, no significant relationships were found between caseload factors and job stress or satisfaction. However, one employment factor (paperwork) was a consistent predictor of all three stress measures. An analysis of open-ended responses indicated that responding SLPs were more challenged by employment-related factors than by student-related issues. Implications regarding the critical shortage of SLPs will be presented.

Job Stress of School-Based Speech-Language Pathologists

Stress and burnout contribute significantly to the shortages of school-based speech-language pathologists (SLPs). At the request of the Utah State Office of Education, the researchers measured the stress levels of 97 school-based SLPs using the Speech-Language Pathologist Stress Inventory. Results indicated that participants' emotional-fatigue manifestations, instructional limitations, biobehavioral manifestations, lack of professional supports, and total stress were significantly below that of the original national sample. However, of the 48 survey items, participants' responses indicated more stress in three specific areas, namely, caseload size, salary, and the use of prescription drugs. Caseload and salary have been identified in other studies as major sources of stress for SLPs. No significant differences in stress were identified with the type of school district (rural and urban), number of years' experience, or number of students served. Efforts to reduce stress levels of SLPs should be aimed at increasing supports, reducing caseloads, and increasing salaries.

Implementation of Integrated Dual Disorders Treatment: A Qualitative Analysis of Facilitators and Barriers

Implementation of Integrated Dual Disorders Treatment: A Qualitative Analysis of Facilitators and Barriers

Salary Stipend Targets Recruitment, Retention

Salary Stipend Targets Recruitment, Retention

The Role of Supervision in the Retention of Public Child Welfare Workers

Contrary to common belief, having a manageable caseload size may not be critical to the retention of child welfare MSW social workers. In this study of the retention of 765 title IV-E MSWs in public child welfare, support from supervisors emerged as a pivotal factor in employee retention. With analyses regressing retention and intent to leave public child welfare agencies, support from supervisors emerged as a predictor, but caseload size did not. The preliminary findings of qualitative interviews corroborated these results. This study corroborates literature indicating that support from supervisors enhances retention of specially trained child welfare workers.

Using activity data to explore the influence of case-load size on care patterns

Using activity data to explore the influence of case-load size on care patterns

Expert ratings on the critical ingredients of supported employment for people with severe mental illness.

Supported employment is identified as an evidence-based practice for people with severe mental illness, with Individual Placement and Support (IPS) emerging as the clearest articulation of this practice. Yet throughout the U.S., programs labeled as supported employment operate in a wide variety of ways, with different staffing patterns, organizational features, and services. Consensus on critical ingredients is crucial for establishing standards for evidence-based services, guiding implementation of new programs, and fostering communication in the literature. The current study examined the degree of agreement on the critical ingredients of supported employment among experts and practitioners. The expert sample (n=19) consisted primarily of university-based researchers, while the practitioner sample (n=55) was a convenience sample generated from lists provided by state leaders in 2 Western, 2 Central, and 2 Eastern states. Using multiple sources, including published guidelines and 3 supported employment fidelity scales, we developed a 59-item survey checklist. Respondents rated items on a 7-point importance scale and indicated ideal specifications in 11 areas. We found strong agreement on the critical ingredients of supported employment within the expert and practitioner groups. On most items, the two groups had similar mean ratings of importance. Experts rated 4 items reflecting evidence-based principles and 2 items related to outcome monitoring as more important than did practitioners, while practitioners rated as more important 10 items reflecting pragmatic concerns (e.g., funding, accreditation). Comparing survey responses on the 15 items from the IPS Fidelity Scale suggested general endorsement of IPS principles, except in the area of staffing. Ideal model specifications included caseload size of 16 and twice weekly supervision. Respondents also suggested critical ingredients not measured by the IPS Fidelity Scale, such as benefits counseling, supported education, a cultivation of employers. This survey shows a growing consensus within the psychiatric rehabilitation field on IPS principles while suggesting additional strategies endorsed by experts and practitioners.