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HEALTHY FAMILIES MASSACHUSETTS POLICIES & PROCEDURES

CASELOAD MANAGEMENT
HEALTHY FAMILIES MASSACHUSETTS (HFM) is committed to providing high quality home visiting services to families. To ensure this high quality, home visitors must have an adequate amount of time to prepare for home visits, to spend with each family during the actual home visit, to maintain collateral contacts, and to document the delivery of services. Caseload management is an essential tool in maintaining high quality home visiting services so that HFM programs can meet families unique and varying needs. Active caseload management is an ongoing process that involves the program participant, the home visitor, and the supervisor. Program participants contribute through discussion with home visitors about their service level and how the program can support them. Home visitors contribute by regularly discussing in supervision the demands of delivering services to each family on their caseload. Supervisors contribute by managing each home visitors overall caseload, ensuring it meets parameters set out in this policy, meets the needs of each family, incorporates the skills of each home visitor, and helps the program achieve projected program capacity. Caseload management not only assures quality service delivery, including appropriate linkage to community resources, but also that home visitors do not become overwhelmed, resulting in better staff retention. Caseload management assures that supervisors are able to maintain a steady support and familiarity with each of the program participants assigned to the home visitors whom they supervise, as well as maximizing program resources. These policies and procedures for caseload management guide HFM programs so that they can meet the goal of providing high quality, intensive home visiting services to program participants. HFM caseload management policies and procedures are divided into four sections: Caseload management systems; Developing a caseload management system; Implementing a caseload management system; and Documentation. I. CASELOAD MANAGEMENT SYSTEMS Caseload management is the method by which programs determine the appropriate total number of participants with whom a home visitor can reasonably work and maintain a high level of quality in delivering intensive home visiting services. This determination is based on information gathered from a variety of sources, including from program participants, the home visitor, observations made by the supervisor, and program contractual obligations.
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All HFM programs are expected to develop a Caseload Management System (CMS) to standardize this process in accordance with best practices. Each programs CMS must balance requirements for both caseload and case weight. A. Caseload Caseload takes into account the number of primary participants and their assigned service level. This number includes those participants assigned to any service level, including Outreach, Engagement, or Re-Engagement. To assure that home visitors have an adequate amount of time to spend with each family to meet the families needs and plan for future activities, caseloads are limited. Limits are based on home visitors fulltime equivalent status (FTE); if a home visitor works less than full-time, programs must adjust the caseload on a pro-rated basis. Maximum caseload for a home visitor working full-time is: No more than fifteen (15) participants at the most intensive level (weekly or more often); or No more than twenty (20) participants at any combination of service levels. Programs may find that in order to provide individualized, quality HFM services, average caseloads should not reach this maximum amount. This 15/20 standard is a maximum amount and not a caseload size for which to strive. NOTE: If a family has two primary participants, each is counted toward the number on the caseload. B. Case Weight The HEALTHY FAMILIES MASSACHUSETTS Implementation Team (HFMIT) recognizes that each participant possesses unique strengths, challenges, resources, and abilities. The intensity of work with each participant varies based on those factors, as well as others, such as involvement of a secondary participant, community resources, linguistic barriers, social support systems, geographical distance, and developmental life phases. The amount of effort, time, or resources to ensure that families are provided with quality services may vary from family to family, or vary at different times in the familys life. To take this intensity into account when managing caseloads, programs must develop a system to assign a numerical value to each case and implement this system when assigning cases to home visitors. This numerical value, or weight, is based on objective factors and is applied consistently and fairly to all program participants. The following factors must be incorporated into any formal system for managing home visitor case weights: service level to the participant at any one time; experience and skill level of the home visitor assigned; the nature and difficulty of the problems encountered; linguistic barriers the home visitor is directly addressing (translating curricula or program documents; interpreting during visits, etc.); the work and time required to serve each family/participant;
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the number of families/participants per home visitor which involve assessment and/or more intensive intervention; travel and other non-direct service time required to fulfill the home visitors responsibilities; and extent of other resources available in the community to meet family/participant needs.

In addition to the weight assigned to each primary participant on the home visitors caseload, other duties (e.g. group facilitation, significant administrative duties, etc.) should be assigned a weight based on factors such as time necessary to complete the task or skill level of the home visitor. Including these discrete duties in the home visitors overall case weight capacity is key to ensuring he/she is not overwhelmed and is still able to prepare sufficiently for home visiting. In addition, programs should ensure that there is room on the caseloads of home visitors to take on additional participants in the event of program situation where another staff members caseload needs to be transferred, either temporarily or permanently. II. DEVELOPING A CASELOAD MANAGEMENT SYSTEM (CMS) Programs must develop a formal system to conduct caseload management that includes: a written program policy, a standardized system for managing caseloads, a formal system of documenting each home visitors caseload and case weights, and the overall program caseload. A. Elements of a Caseload Management System Caseload Management Systems are formalized and standardized to promote the consistent and fair implementation of the system. While home visitor and supervisory judgment based on knowledge and experience are an important aspect of managing caseloads, they cannot be the only influence. The following elements must be reflected in any CMS: participant-associated characteristics, home visitor-related factors, and agency-driven elements. 1. Participant-associated characteristics include but are not limited to: Age of primary participant(s) Number of primary participants Number of secondary participants Size of family Linguistic needs of the family (including interpreting and translating in support of HFM service delivery) Cultural considerations presented by the family Level of isolation in formal or informal support networks Health concerns - physical, emotional, cognitive, and developmental Education and literacy level Family interpersonal dynamics Resources available to the family Stability of living arrangements Financial concerns
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Additional stressors (may include but not limited to reproductive health history, family history of violence, family history of substance abuse, or a family history of child abuse and neglect)

2. Home Visitor-related factors include but are not limited to: Individual home visitors work hours (e.g. full-time or part-time) Current caseload remains within standards for limited caseload size Impact of new case assignment on current caseload, including the overall balance of participants at varying service levels (with particular attention to the number of cases on Outreach, Engagement, or Re-Engagement) as well as striving to achieve a mix of lower-intensity and challenging participants Skill level of the home visitor Match between the participant and the home visitor, taking into consideration the following: o Linguistic ability; o Travel time (this may vary by home visitor based on where they live relative to the participant and can be considered a factor); and o Personality traits and temperament to help facilitate relationship building. Time required to document service delivery Regularly scheduled obligations, such as reflective supervision, team meetings, required HFM training, etc. Anticipated leave by the home visitor (vacations, planned medical or parental leave) Anticipated end of employment NOTE: New home visitors should carry a smaller caseload until they have completed required trainings. Supervisors should assess home visitor skills and training obligations with an eye to gradually building full caseload capacity. 3. Agency- and Program-driven elements including but not limited to: Standard agency work week Formula for weighing part-time staffs program responsibilities Time allotted for lunch and breaks Agency trainings and meetings Agency documentation duties Coverage of other home visitor caseloads due to illness, parental leave, vacation or unfilled positions, etc. Projections for program to meet its contractual obligation to serve a specific number of families each fiscal year

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NOTE: Programs may adjust caseloads based on a variety of HFMIT approved factors. HFMIT expects that the average caseload for programs is fifteen (15) participants per FTE home visitor. Programs must take into account contractual obligations in serving families throughout each fiscal year when monitoring caseloads in their programs. Please submit a Technical Assistance (TA) Ticket via the TA Help Desk at CTF_TAhelpdesk@massmail.state.ma.us III. IMPLEMENTING A CASE MANAGEMENT SYSTEM A. Maintaining Balance for Your Home Visitors In keeping with the HFM SERVICE LEVEL POLICY, supervisors must take into account that HFM services are offered intensively with well-defined criteria for increasing or decreasing intensity of services over the time span of a participants involvement in the program. Caseload management must reflect the current status of the home visitors caseload while anticipating upcoming changes as much as possible. In addition, programs should ensure that there is room on the caseloads of home visitors to take on additional participants in the event of program situation where another staff members caseload needs to be transferred, either temporarily or permanently. Managing each home visitors caseload by remaining within the limits for number of participants is essential. Equally important, however, is achieving balance not only by numbers or weight, but with an eye to the mix of low-intensity families and those who present more challenges in providing home visiting services. Each supervisor must pay careful attention to the overall caseload and how it is impacting the home visitors ability to deliver quality services. A home visitor with a high number of participants on Engagement or Re-Engagement may experience ongoing discouragement, impacting their sense of effectiveness. On the other side of the spectrum, a home visitor with a high number of participants who are being seen monthly and/or are about to age out of the program, may find themselves similarly challenged but for different reasons. Exploring the impact on the home visitor of the overall caseload is an important aspect of caseload management in the context of reflective supervision. Therefore, review of caseload must take place within the supervision session. Additional factors to consider when managing caseloads include the following: The impact of program participants in crisis. Balancing caseloads anticipates the impact on the home visitor if many families in their caseloads are in crisis at the same time. The potential for families currently on Engagement or Re-Engagement service level to take part in regularly scheduled services. Since the potential to regularly take part in active services is present at any time with families at these service levels, caseloads must have room for this to occur. Home visitors planning to change jobs. If a home visitor gives notice that he or she will be ending employment, this must be taken into consideration when assigning new referrals. The impact of progressive discipline measures being taken with a home visitor. This would preclude the assignment of new participants. Given the relationshipHEALTHY FAMILIES MASSACHUSETTS Caseload Management Policy September 2011 Page 5

based nature of HFM services, the possible termination of a home visitors employment early in a new relationship would have a negative impact on that participants view of services. Supervision Spotlight: Supervisors may find that tracking caseload and case weight on a more frequent basis will be more effective in responding to participant needs, as well as home visitor sense of satisfaction with the job. HFM home visitors vary in the strengths and challenges they bring as a part of their skill set. There are times when helping home visitors to grow their ability to maintain a fully weighted caseload becomes a focus of reflective supervision. Helping home visitors with time management, documentation, and creative outreach skills can have a direct impact on the home visitors ability to successfully carry a full caseload. B. Maintaining Balance in Your Program Even with increasing demand for services (e.g. increase in number of referrals, staff transition, etc.), programs must maintain compliance with their own internal case weight policies. IV. DOCUMENTATION Documentation is important in helping program managers and supervisors understand their programs overall capacity to serve participants, as well as in tracking the provision of services. Programs that demonstrate active caseload management will meet the goal of limiting caseloads to ensure quality home visiting services. In addition, using a standardized system of weighting cases can be an effective tool in supervision, for understanding trends and growing home visitor skills. Supervisors must document management of caseloads on at least a monthly basis. Overall caseload management for each home visitor comes out of regular case review (see HFM CASE REVIEW POLICY). Documentation in the supervision log includes: regular (at least monthly) discussion in supervision about the appropriateness of service level assignments; inclusion of copies of any service level assignment or service level change forms completed with the participant; regular (at least monthly) discussion in supervision about the appropriateness of case weights for each family; and review the overall caseload and case weight with the home visitor (at least monthly). Programs must keep records of their use of the CMS. If supervisors track the programs overall CMS in one place, then they must keep that documentation in a single CMS binder. If supervisors track the CMS for each home visitor separately, then they may keep that documentation in each home visitors supervision log. Use of either approach for documentation must include: system for tallying caseloads and case weights; and at a minimum, a monthly tally of each home visitors caseload and case weight. Please submit a TA Ticket to the HFMIT via the TA Help Desk at CTF_TAhelpdesk@massmail.state.ma.us for assistance regarding this policy.
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