Providing high-quality and cost-effective services in family and mental health treatment programs is difficult. There is an elusive balance between (a) maximizing patients served and positive patient outcomes and (b) minimizing provider burnout and turnover. Agencies often implicitly assume that all cases require equivalent provider time and effort and thus assign cases solely to balance each provider’s caseload numbers. However, this assumption ignores factors that can lead to substandard treatment and provider burnout. This study identifies factors that contribute to case complexity and difficulty as part of a program of research to develop a weighted case-demandingness model in outpatient mental health and family maltreatment services in the U.S. Air Force. Focus groups with providers revealed distinct themes related to caseload and effective time management. The generalizability of the findings was tested quantitatively among a larger sample of providers. Results indicate the need to consider environmental, structural, and individual patient factors when determining patient acuity and caseload.