Caseload Management Best Practices

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What Is Caseload Management?

Caseload management allows clinicians to be successful financially and ethically in terms of timely and accurate documentation. It ranges from having an appropriate number of clients on your caseload to completing paperwork, including treatment plan updates, contact notes, and termination notes, in a timely manner. Effective caseload management skills are imperative to quality client treatment, and it is part of what allows clinicians to get paid!

“I hate doing paperwork, I’d rather focus on the client.”

As clinicians, we can all agree that paperwork is not why we joined the field of psychotherapy. Client care includes keeping our charts updated, much like a doctor's office would need to.  There may be times when our notes are subpoenaed, records are requested in a move, a divorce, etc., in which case clients or other professionals may read your documents.  

  • Tips for doing paperwork:  AI Scribe Benefit

It is essential to represent yourself and your clients well.

So, by completing the proper paperwork and staying on top of the To-Do list in TherapyNotes, we are providing the best client care and protecting ourselves as clinicians and our licenses.

Client Retention

What is client retention & why is it important?

Client retention is when an active client engages with their clinician long enough to successfully achieve or partially achieve their treatment goals.  Client retention, in short, is the ability to build rapport and an overall safe and supportive relationship that allows clients to trust in your ability as a therapist in a way that provides them the space to process difficult and personal issues.  As a clinician, client retention is important because it allows us to provide the best possible care for the clients who come to us in search of help. It also gives us stability.  Stability in pay, in scheduling, and in our continued application of therapeutic skills. We can also understand that retention patterns vary naturally, per season, weather, school schedules, and holidays so the following is regarding anything outside of ‘typical’ private practice ebb and flow.

  • Does your caseload often feel low?
  • Do you experience frequent no-shows?
  • Do you email admin regularly to remove clients from your caseload?
  • Do you worry weekly or daily about scheduling enough clients to pay your bills?

If you answered yes to one or more of the questions above, client retention may suffer.

Solutions to retention issues:

  • Evaluate the clinical relationships with your clients.
  • Does this client feel safe talking with me?
  • Does this client feel validated in conversations?
  • What is the overall rapport with this client?
  • Do you have a clear case conceptualization before you challenge the client?
  • Check-in with yourself
  • Are you closing out cases before the client’s goals are reached due to your frustrations with the client or their progress?
  • Are you feeling irritated by the client’s issues?
  • Is the client making you angry by showing up late....again?
  • Is there a specific type of client you’re struggling with?
  • Gender, age group, or type of issue?
  • Evaluate the method of therapy used.
  • Don't forget to assess the form of treatment you’re using while evaluating client retention.
  • Solution-focused Brief therapy (SFBT) will likely decrease the time a person spends in therapy, while narrative forms of treatment may take longer.
  • Revisit the Late Cancels/No Show section.

We are in an odd field that requires us to examine ourselves and evaluate our effectiveness. If you need/want validation or support in this process, check in with Garrett Luttman or Jennifer Luttman.  Also, review this document:  How to Fill Your Caseload Faster.

  • If you’re struggling with these issues, it could be helpful to seek supervision.
  • Remember that clients are coming to you for help with vulnerable personal issues. If we do not build rapport, they will likely not return.
  • 85-90% of success in therapy comes from the therapeutic relationship.

Managing Paperwork and Time

It isn’t uncommon to feel bogged down or overwhelmed by paperwork. If you find yourself struggling to get your paperwork done in a timely manner check out these options.

Intakes

  • By asking the questions on the intake form in the initial meeting, you will gather copious amounts of information from the client and the information will be directly from the client. The intake can take a bit of time to type up, it’s okay to type brief and important portions of information with the client present.

Initial Treatment Plans

  • The client should engage in their treatment planning. It can be an excellent opportunity to have printed copies of blank treatment plans with you for new sessions so you can write notes with the client present or go ahead & type.

Progress Notes

  • If you are skilled at ending sessions between the 53+ minute mark you could benefit from using ~5 of those minutes to complete the note for the session you just ended. That way the information is fresh & your notes are almost always caught up.
  • If notes take more than ~5 minutes to write please check in with Jenny to get ideas on how to shorten that time.

Termination Notes

  • If a client has not been seen or been in contact for 30+ days, go ahead and close out their case.
  • An email can be sent to confirm they are interested in sessions or not and to inform them that their case will be closed out.
  • You can let them know we are there if they need us again.
  • If a client has no-showed or late canceled 3 or more times go ahead & inform them of this violation and close out their case.
  • If a client has not been seen in 30+ days but has been attempting to be in contact send them an email or leave a voicemail informing them that they will be closed by “x” date if they are not scheduled by that time. If they are not scheduled by “x” date go ahead and close.
  • Remember, prompt terminations are important and clients can come back to Overcomers for services after they have been terminated.

Learn how to speed up note writing with our AI Scribe:  AI Scribe Benefit

Optimizing Your Appointments/Availability

Caseload size

  • Clients may be constantly readjusting to how often they would like to be seen, think weekly, bi-weekly, monthly, etc, which means that you are likely needing to adjust the number of clients on your caseload frequently.
  • Don't be afraid to take on a few more clients than you can schedule in a week, this allows you to have a backfill list. Many clinicians that have 30-35 open client spaces a week have caseloads between 45-60 clients.

New Client Requests

  • When opening up for new clients, expect some no-shows when scheduled. You are able to request 2-3 more than you may want in your schedule to account for this.
  • You are also able to keep a close eye for fear of overload if they may ALL show for sessions. You can request the exact number you want. You can request new clients if you end up getting no-shows, but know this can then take time to fill.

Prompt closures

  • Terminating clients off your caseload promptly allows you to have less liability with no longer engaged clients. It also allows you to have a clearer picture of how many new clients you may need.

Offsetting Cancellations and No-shows

Late Cancels/No shows Backfilling

  • Keep a list of clients that would like to come in sooner than their next appointment & use this list to attempt to backfill canceled appointments. This list can be a lifesaver for clients & your schedule.

Personalized Reminders

  • Contact your client 24 hours or less ahead of their scheduled appointment to remind/confirm the appointment. This lets them know you are thinking of them and interested in meeting.

Don't use recurring appointments

  • Recurring appointments can leave your schedule vulnerable and stagnant. By stopping recurring appointments, you are asking your clients to recommit to their treatment consistently and thus recommit to showing up for scheduled sessions.
  • If you do choose to use recurring appointments, have a personal policy for how they can be' earned'.
  • Example: Clients who have appeared at 3 or 5+ appointments on time, without rescheduling/cancellations, and maybe demonstrate they are engaged and committed to the therapeutic process.
  • Have a personal policy for how/when people ‘lose’ the slot, making it open for other clients.
  • Example: If the client cancels two times in a row, are continuously late, etc.

3-6 month reviews

  • Reviewing the policy regarding late cancellations and no-shows simultaneously as treatment plan reviews can be a less awkward way to decrease these occurrences.

Outreach

  • It is appropriate to contact clients for multiple reasons outside their scheduled session time, and many times, the contact can turn into a billable hour.
  • Some ideas include checking in by phone with a client who was not doing well at the last session or contacting a child's parent to find out more information on how the child is doing with treatment.
  • Identify the clients' or the parents’ willingness to contact each other between sessions or by phone and their understanding or agreement of the billing for these impromptu meetings.

Know tomorrow's calendar

  • By being aware of who is on your calendar the next day, you are already preparing for predictable cancelations/no-shows and tardiness. This provides the opportunity to have a plan for who to backfill with or who to call if the client does not show up. It is also a chance to prepare for updating billing information and gathering new data for treatment plans.

Appointment scheduling

  • Do your best to include the primary caregiver in scheduling and updates. This allows them to plan travel and also be engaged in treatment effectively.