Caseload Management: Choosing Suitable Clients in a Community Health Clinic Agency

Discretion in decision-making is a well-known but poorly understood phenomenon. This paper examines the contextual features influencing the exercise of discretion in screening and assigning clients in a community mental health agency. I develop a caseload management model to analyze the interplay between organizational circumstances, determinations of client suitability, and decision-making outcomes. This study finds: (1) Decisions are based on judgments of client suitability. (2) These assessments use stereotyped characterizations to typify clients as suitable. (3) The typifications serve as a means of limiting the allocations of scarce treatment resources. I describe the related common-sense reasoning and decision-making practices which I observed.