Article critique

Article critique

Piloting a points-based caseload measure for community based paediatric occupational and physiotherapists

Throughout the province of British Columbia (BC), not-for-profit agencies hold contracts to provide early intervention pediatric therapy for children from birth to five years of age. These contracts are funded by the Ministry of Children and Families (MCFD). Provincial recruitment and retention of therapists are ongoing issues recognized by MCFD; reports exploring these issues over the past eight years have identified workload and workplace stress as key concerns to address in recruitment and retention strategies. Currently, caseload sizes vary widely among agencies and therapists involved in pediatric early intervention both nationally and within BC. There are few guidelines available to inform manageable caseload size.

Literature supports the need to provide guidelines for caseload size and workload. High caseloads are linked to decreased job satisfaction consistently across allied health literature (Cawthorn & Rybak, 2008; Fortune & Ryan, 1996). More equitable caseloads contribute to lower levels of nurse burnout and better retention of staff (Ferrant, 2004). Cameron, McLean, and Namazi (2001) reported that 100% of therapists surveyed felt that a manageable caseload was very important in ensuring that therapists without pediatric experience were successful when hired. One third of therapists stated that an overly large caseload was a factor that might influence them to leave their current jobs (Cameron, et al.). Stewart (2006) reported that only 40% of paediatric early intervention physiotherapists and 30% of paediatric early intervention occupational therapists in BC felt able to provide an adequate level of service due to workload issues. In a survey of pediatric physiotherapists, some respondents were considering leaving physiotherapy practice because of job dissatisfaction, and 45% cited high caseloads as a major factor (Physiotherapy Association of British Columbia, 2000)(Kathy, 2177, 250).

Nursing, rehabilitation, and social work literature revealed that caseload weighting strategies had been explored and developed in acute care, hospital-based outpatient settings and community-based practice. Factors affecting caseload weight varied among settings and disciplines, and it was evident that weight was specific to practice settings and programs. However, commonalities affecting workloads did exist, including travel time, caseload maturity, frequency/length of visits, client complexity, and manageability (Cawthorn & Rybak, 2008; Dyson, Duckett, & Allen, 2000; Erlendson & Modrow, 2003; Ferrant, 2004; Fortune & Ryan, 1996; Haylock & McGovern, 1989; Interior Region Funding Committee, 2008; Lechman, 2006; Murchland & Wake-Dyster, 2006; Papathanasiou & Lyon-Maris, 1997; Parker-Taillon, 2005; Pollard, 2006; Stewart, 2006). Clinical experience, familiarity with models of service used in pediatric therapy in BC, and the evidence from the literature were all used by the researcher to inform the development of the pilot questionnaire. Prior to starting the project, the questionnaire was introduced to and reviewed by three practicing occupational therapists and physiotherapists, and the preliminary feedback from these clinicians served to modify the initial draft. The purpose of the project was to pilot this caseload measure and to determine its potential for further development.

Methods

Participants

Participants were recruited through purposive sampling. Participants meeting the inclusion criteria were occupational therapists or physiotherapists working in early ...