Size Of Caseload Research Articles

Team midwifery: The views and job satisfaction of midwives

Objective: as part of an evaluation of a team midwifery scheme we assessed the satisfaction of community and hospital midwives and their views about working practices and care provided. Design: survey of complete enumeration of community midwives (most working in teams) and hospital midwives providing antenatal, intrapartum and postnatal care to a population of women. Setting: community and district general hospital, in the UK. Measurements: socio-demographic data about midwives, ratings on Likert-type scales of job satisfaction, quality of care variables, relationships with other professionals and women; Glasgow Midwifery Process Questionnaire. Findings: 80 out of 92 midwives (87%) responded. Community midwives were younger, more recently qualified, employed on lower grades, less likely to be married and have children than hospital midwives. The Glasgow Midwifery Process Questionnaire revealed that midwives, particularly hospital midwives, had low morale. Community midwives were more likely to report that their job was satisfying, offered a variety of work, enabled them to use skills and knowledge fully, and offered opportunities for professional development. Hospital midwives were more likely to report following strict guidelines. Community midwives, however, disliked the long on call and unsociable hours, and reported disruption to family/social life. Forty-one per cent of hospital midwives (12) and 28% of community midwives (14) reported regularly working beyond their shift. Whilst midwives thought that team midwifery was, in theory, a good idea, in practice it was not working well because of the size of teams and caseload. About half the community midwives felt that teams had detrimentally affected the quality and continuity of care. Conclusions: whilst team midwifery aims to improve continuity of maternity care, in this instance, it does not appear to achieve this aim. Many midwives reported it had adversely affected care. Team midwifery is a source of disillusionment for midwives, since the continuity of carer ideal is unachievable in a system based on teams of seven or more. Attendance at the delivery may be a luxury provided at the expense of antenatal and postnatal continuity. Implications: midwives recommended remedial measures: reducing team sizes, reducing caseloads, ensuring teams were fully staffed, reducing ‘on call’ and labour ward hours. It remains to be seen whether these will have the desired effects on continuity of care.

A Survey of North American Specialist Foster Family Care Programs

Over the past 10 years, specialist foster family care services have emerged as a distinct child welfare service. Snowballing sampling techniques were used to identify over 1,200 possible North American specialist foster family care programs; 293 met six criteria established as defining a specialist foster family care program. Data on the programs, ranging from size, number of clients, foster parent training, size of caseload, length of stay, and intervention techniques, are presented.

Explaining The Pace of Civil Case Litigation: The Latest Evidence From 37 Large Urban Trial Courts

This paper analyzes data on caseload size, caseload characteristics, case management features, and civil case processing times in 37 large urban trial courts, the largest number of state general jurisdiction trial courts ever included in a study of the pace of litigation. First, the paper concludes that most courts are far from meeting the American Bar Association civil case disposition time standards, especially the standard that 90 percent of all cases should be disposed within one year after filing. Second, bivariate and multivariate analysis reveals, as expected, that the size of the pending caseload per judge is the strongest correlate of median and 90th percentile case processing times, though the causal relationship between pending caseload per judge and the pace of litigation is unclear. The number of filings and dispositions per judge, however, were not related to the pace of litigation. Interestingly, courts in counties with larger populations were also more likely to have larger pending caseloa...

The initial examination for a Certificate of Added Qualifications in Surgery of the Hand.

A total of 510 candidates took the 1989 Examination for Added Qualifications in Surgery of the Hand, including 412 diplomates of the American Board of Orthopaedic Surgery and ninety-eight diplomates of the American Board of Surgery. Most candidates reported that they had intensive practices in hand surgery and large annual case-loads, and most had taken a hand fellowship. However, there were significant differences between diplomates of the American Board of Orthopaedic Surgery and diplomates of the American Board of Surgery regarding these variables. The psychometric characteristics of the examination were very good. The average difficulty value was 77.6 per cent correct. The average item-discrimination value was high, and the total test reliability coefficient was 0.89. In general, the candidates' performance was very good, although there was a wide range in scores. A passing score of 66.3 per cent correct was selected, resulting in an over-all failure rate of 7.6 per cent, with 471 candidates passing and thirty-nine failing the examination. There were significant relationships between performance on the examination and several background variables, such as percentage of practice in hand surgery, having taken a hand fellowship, and size of the annual case-load.

Structured Case Recording in Child Welfare: An Assessment of Social Workers' Reactions

Recording in child welfare traditionally that are redundant and irrelevant to their has taken the form of a chronological narprovision of service to clients, rative. Structured records, however, The authors conducted a secondary specify types of information to be includanalysis of data originally collected 6 ed and require line workers to record years earlier as part of a larger evaluation case information under established of the implementation of the UCR system categories. Examples of structured in New York State (Edwards M Kane, evidenced by the recent mandating of 1974; Weed, 1969); the structured such systems in several states (Streat, clinical record (Videka-Sherman & Reid, 1987), and because little information ex 1985); the chronolog (Kagle, 1984); and ists about workers' experiences with the Uniform Case Record (UCR) (Weisuch systems, the data analyzed in the fare Research Institute, 1982). study are instructive despite the fact that Advocates of structured records argue the data are not more current, that they have several advantages (Reid The study's focus was on line workers' & Smith, 1981; Streat, 1987; Videkaevaluations of a structured record used in Sherman & Reid, 1985). Structured child welfare agencies to learn how line records organize case data in a manner workers assessed the utility of this kind of that permits users to locate needed inforrecord as a tool for providing services to mation quickly. The information obchildren and their families. The authors tained is more likely to be pertinent and also wanted to learn whetherworkers' ap omissions are less likely to occur. In adpraisals of the structured record varied dition, the structured, compact organizaaccording to such factors as job position, tion of data facilitates processing for size of caseload, or time demands per computerized information systems (Mutceived as the result of recording, schler & Hasenfeld, 1986). Structured The perspective of line workers is records also provide a means for ensurcritical to an evaluation of structured ing line worker accountability in carryrecords for at least three reasons. First, ing out service requirements. because structured records tend to be However, structured records also have designed for management needs, learn limitations (Beinecke, 1984; Reid, 1978). ing whether they also serve the needs of They impose a fixed structure that may line workers who are the direct service not allow for the variety of case situations providers is important. Second, as com and that may result in information that pilers of the case records, line workers is superficial and inadequately detailed, are in a unique position to assess the Such records also may reduce line usefulness and quality of the information worker autonomy and flexibility, which obtained. Third, regardless of the value not only may lead to a reduction in the of the information for service and quality of the data obtained but also may managerial purposes, the monetary and engender worker frustration and resentpsychological costs of recording (such as ment. Further, workers sometimes comtime spent and dissatisfaction) are impor plain that structured records require tant factors that cannot be assessed ade them to engage in recording activities quately without input from line workers. Line social workers' assessments of one structured recording format (UCR) were examined. A format that has been used widely in child welfare agencies throughout New York state since 1981, UCR is an outgrowth of New York's Child Welfare Reform Act of 1979 (CWRA), which was a precursor to the federal Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272). UCR established recording guidelines to ensur hat practices of line social workers reflected the CWRA philosophy of prevention and permanency planning. The record for each case included eight to 10 pages of forms that required nar rative recording and several additional pages of checklists. Line social workers were required to perform specific ac tivities nd to complete various reviews and reports at intervals of 1, 2, 3, 6, 9, and 12 months.

A demonstration of the cost benefits of case management services for discharged mental patients.

The authors report on a demonstration of the cost benefits of case management for hospitalized mental patients discharged from a New York State Community Mental Health Center to community living in a rural catchment area. Case managers promoted social rehabilitation and maximized time spent in the community. Comparison of the treatment group with matched controls on frequency and duration of rehospitalization during the 15 month intervention period shows a benefit conservatively estimated as 2.03 to 2.72, depending on size of case load.

On the reputation of state supreme courts

A state supreme court, in making and justifying choices, uses a variety of sources of information and authority—its own precedents, scholarly commentaries, articles in law reviews, encyclopedias, restatements, and so forth. Quite often a state supreme court appeals to the wisdom or rejects the lack of it in the decision of a sister court in order to arrive at or buttress reasoning in a particularly problematic case. These citations—construed as derogation or deference—yield very handy and nonreactive indicators of hierarchies of prestige between and among the highest appellate courts of the several states. In this paper, I develop a simple and general measure of judicial reputation, present evidence on the hierarchy of state supreme courts as of 1975, show how this ranking has changed in the last 50 years, and examine competing and sometimes complementary explanations of judicial prestige. Taken together, social diversity, judicial professionalism, political ideology, and the size of case load provide an impressive explanation of the reputation of state supreme courts.

Social Services in AFDC: Steps toward Evaluation

This study takes certain steps toward evaluation of the social services provided AFDC recipients in 1967 by (1) determining characteristics of welfare workers that are associated with the provision of services and (2) measuring the degree to which provision of service is associated with certain welfare-relevant social objectives. Size of case load has some effect on social services, but salaries, turnover, and level of employee education do not. Provision of social services is related to only some of the social objectives.

Inquiry into the use of psychotherapy for hospitalized schizophrenics.

Questionnaires were sent to hospital administrators who referred them to their clinical directors, chiefs of service or directors of professional services. The data thus obtained represent the judgements of psychiatrists with varying degrees of training, a variety of philosophies of treatment and a variety of types of hospital facilities. The data which have been collected constitute current judgement values. Those respondents who could not draw on specific experiences within their own hospitals did not offer judgement values. The opinions expressed–though sometimes based on impressions from experience rather than on organized evaluative studies–are essentially from hospitals where therapists have experience with both psychotherapy with schizophrenics and the somatic therapies. The data in this report are based upon a survey of more than 150,000 hospitalized schizophrenics in more than 300 psychiatric facilities of various types. The bulk of the schizophrenic patients in this sample ( 79%) are hospitalized in the various state institutions; the V. A. facilities account for an additional 17% and the remaining 4% are hospitalized in the private hospitals. The percentage of the schizophrenic population receiving psychotherapy is lowest in the state hospitals and highest in the private hospitals. The extent to which psychotherapy is employed in a given type of facility does not necessarily indicate the attitude of the personnel of that facility regarding its efficacy. Closely correlated with the extent to which psychotherapy is employed is the size of the psychiatrist's case load. The number of ancillary personnel trained in the use of psychotherapy appears to be negligible. Hypnotherapy and psychoanalytic therapy were found to be used in less than 1% of hospitalized schizophrenic patients. Of the few who receive these therapies, most of them are being treated in the private facilities. The judgements obtained view psychotherapy as more or just as effective as the vocational, recreational, occupational and milieu therapies, and on a par with ECT and insulin coma therapy. Pharmacotherapy is viewed as the superior treatment. The majority of respondents favor (in emphatic terms) somatic therapy in the treatment of schizophrenia. The data suggests that psychotherapy is infrequently employed as the primary or sole treatment. As an adjunct to other methods it enjoys wider (though limited) popularity and acceptance. This survey indicates that psychotherapy, in the treatment of hospitalized schizophrenics, is not used as extensively as other forms of therapy. The consensus suggests that it has little value as the sole method of treatment and that its merits may be only as an adjunct to the somatic therapies. Psychopharmacotherapy appears to be the treatment of choice for this group of patients, and this is reflected in the relatively small proportion of hospitalized schizophrenics receiving psychotherapy at any phase of their illness. An inference from the data may well be that the type of schizophrenic process found in the chronically hospitalized patients is not generally responsive in a major way to psychotherapy. Additional factors obviously are large caseloads and limited trained personnel to carry out psychotherapy. The small or private hospitals report a much more frequent use of psychotherapy. The findings of this preliminary survey describe in a general way a nationwide picture of the use of psychotherapy in the treatment of hospitalized schizophrenics and the attitudes, whatever their derivatives, towards its usefulness. Studies of a more definitive nature will doubtlessly become increasingly available. Even more necessary will be studies of the types of patients treated with psychotherapy, an exploration of the nature of the psychotherapy employed, and a more refined analysis of the derivatives of attitudes regarding the efficacy of psychotherapy.