Caseloads as Outcomes
Determining the number of clients per CHW’s caseload can be difficult. They depend on the extent of interaction with a client and the intensity of the services provided. For intensive programs with lots of documentation requirements, CHWs could have as few as 10 cases21. Comparing programs over several years, caseloads range from 10-30 clients at any given time if CHWs are providing comprehensive services21. However, there are instances where CHWs have caseloads with nearly 60 clients, and some have even more21. In these instances, only a few clients required intensive intervention. Yearly caseloads will be determined by the length of time that clients spend in the program.
When considering caseloads, look at local, regional, or national programs that target similar outcomes. Another way to approach caseloads is to consider how you want your CHWs to spend their time. Don’t forget to include training, program meetings, and documentation in this consideration. These activities are essential but are often accidentally excluded.
Estimate how many in-person visits and phone calls you expect each client to need, add in the time for travel, training, and documentation. Add extra time if CHWs are working with clients to acquire very scarce resources, such as affordable housing. Use these estimates to get a rough idea of a manageable caseload based on the number of hours a week CHWs will be working. Don’t forget to include lunch and other rest periods as needed.
Questions to consider:
- How many cases are in-person visits versus phone calls or texts?
- Are your CHWs having to drive long distances or take public transit to appointments?
- What is the approximate amount of time CHWs will spend on documentation?
If your program is already up and running, consider doing a short time-study. Have CHWs use paper or an app to track their activities in 15- or 30-minute increments for a couple of weeks. Though most people change their behavior simply from tracking their time, you should be able to get a rough estimate of how long parts of the job are taking. Managers should stress that this tracking exercise is not a punishment or a draconian management measure; it is simply to determine if their workloads are manageable.
Often, clients who are referred from different sources have varying levels of need. Adjusting caseloads by referral source can be an efficient way to make these distinctions. One persistent problem is the cyclical nature of referrals. Some referral sources will send potential client lists once a month — leading to an avalanche of work for the CHWs. Having a process to fairly distribute clients or alter enrollment timelines can help reduce stress. Working with supervisors to monitor and adjust caseloads is extremely important.
HOW TO: ASK ABOUT CASE LOADS
- If you had fewer clients and more time, would you do anything differently? (go with clients to appts, spend more time with clients, etc.)
- Do you ever feel overwhelmed by the amount of work you have?
- Are any of your colleagues overwhelmed by the amount of work they have?
- What do you think an ideal workload for a new CHW would be?
- What is one change to your workload that would make your job more satisfying and sustainable for you?
When asking CHWs directly about their caseloads, ask the questions in different ways to prompt further insight. For example, the first question might identify services the organization is losing. Questions 2, 3, and 4 allow insight on workload of themselves and their colleagues. An ideal workload would allow the CHW to say “well for someone with more experience like me, I can handle…but for a new CHW, they should . . .”
