How To Terminate An Employee In Your Private Practice

Apr
8
2014

I first “met” Licensed Professional Counselor Camille McDaniel when I was hanging out on the Georgia Therapists’ Network.  The thing that first caught my eye is that her involvement there was thoughtful and supportive of her peers.  I’ve been following Camille for a while now watching her build a really useful blog for entrepreneurial counselors.  When I learned that she had hired her mother as her office manager, I had to know more.  That inquiry has led to Camille graciously guest posting today on terminating an employee in your office. 

(If you are interested in writing a guest post, check out the guidelines here.)

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A Guest Post by Camille McDaniel, LPC, NCC, CPCS 

You’re Fired!

I once read somewhere that termination is not something you do to someone; it’s something you do for someone.  This stuck with me and it will be important later in this blog post.

“You’re Fired!”  The phrase is one we have heard on television, read in print, or maybe experienced personally.  It brings up thoughts of a mean aggressor being unfair to a less powerful person who is just trying to make money to feed their family.

Rarely, do we see images of a boss scared to terminate their employee due to fear of seeming mean, being scared of the employees reaction, or the fear that employees will tarnish the reputation of that private practice.

However, these are some of the reasons I have heard for counseling colleagues keeping silent or passive when it comes to this management task.  I admit I have had some hesitation when I needed to take this step with clinicians in my own practice.  Let’s take a look at what it means to terminate an employee and how to get it done!

How to Terminate An Employee in Your Private Practice

 Weeds in Your Practice

You are the master gardener of your private practice.  You help to plant seeds of empowerment with employees and clients, you water those seeds with patience, kindness, and firmness, and you help to identify weeds that are strangling the life out of your private practice.

Weeds can represent many things, not just client challenges within the counseling session.

Weeds can present in the following forms:

  • The apathetic receptionist whose negative presentation can be felt through the phone and in person,
  • The clinician who has their client waiting because they always come to the office 5-10 minutes late for counseling sessions,
  • The clinician who doesn’t have a single note in many of their client files and ignores your requests to get caught up,  or
  • The clinician who attracts clients but can’t seem to keep them beyond 2-3 sessions and you think it may be their clinical skills.

What You Need to Know and Do

When you decide to terminate someone from your practice, you are saying I have identified a weed that needs to be pulled.  Terminating an employee is not just doing something to someone.  You are doing this for the health of your practice, any clients that may frequent your practice, and any referral sources who put their confidence in the quality of your services.

When the day comes to terminate your employee, you want to make sure you have observed a few important practices.  This will help to make sure you are terminating lawfully. (Some information was obtained from the Small Business Administration.)

  •  Communicate and document along the way.  If the person is not performing job duties or following the policies established in the contract they signed, make sure you have shared these specific issues with the individual and documented it in their personnel file before terminating.
  • Have a witness. If you have reason to believe the person being terminated might escalate, have another person in the room with you as a witness and help.
  •  Keep it short, sweet, and to the point.  Terminating an employee shouldn’t drag on.  You want to share the concerns that were not corrected, how this impacts the practice as a whole, and the action that must be taken i.e. termination.
  •  Use active listening.  It’s natural for the employee to want to vent.  Just listen for a moment and let them release the mixed emotions that are likely coming up.  Then gently bring it to a close.
  • Know exactly what you need to collect from the employee.  Make sure to get all copies of keys, files, and any other property that the employee may possess.  Change access to calendars and billing.
  •  Maintain continuity of care.  Have a list of referrals available within your practice or elsewhere for clients to continue to receive care, after their therapist is gone.  You may call them to explainin your sorrow for the departure of their therapist and offer other options for continuing counseling within the group or provide them with outside referrals.
  •  Know when it’s illegal to terminate an employee. Federal anti-discrimination laws prevent employers from firing because of age, race, gender, religion or disability.  You also can’t fire employees for complaining about any illegal activity, or exercising their legal rights including family medical leave, military leave, time off to vote or serve on a jury.
  • Know when you have to pay.  Employers are not required by federal law to immediately give former employees their final paycheck. Some states, however, may require immediate payment. Contact your State Labor Office for information on requirements in your state.

Final Notes on Terminating Your Employee

If the person you are terminating holds a position where they coordinate many daily tasks such as your billing and scheduling, make sure you first know exactly what they do. That includes knowing

  • the systems they interact with,
  • the passwords they have access to,
  • whether their name is primary on any important services you have, and
  • that they cannot remotely access any of your systems once terminated.

Consider this to be a cautionary tale . . . . I recently heard about a psychologist who, after over two decades in practice, had a major setback when a disgruntled secretary turned his practice operations upside down and he didn’t know half of what she had access to in the first place.

Have you ever had to terminate an employee in your practice?  Or, have you ever been terminated from employment?  Drop in today to share what you learned from the experience so that we can better serve our selves, our clients, and our businesses, too.

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About the Author: Camille McDaniel, LPC, NCC, CPCS is the founder andCamille McDaniel director of Healing Psychotherapy Practices of Georgia, LLC in Kennesaw, Georgia.  She is also the creator of an online business called The Counselor Entrepreneur. You can find more about her work at http://www.CamilleMcDaniel.com.

 

 

 

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Informed Consent For Distance Counseling

Mar
26
2014

Every day I speak to therapists who are interested in growing their practices.  Many are exploring the possibility of providing distance counseling.  I’m happy to have Lauren Ostrowski back with us again this week to share with you her thoughts about the informed consent process that is unique to distance counseling.

(If you are interested in writing a guest post, check out the guidelines here.)

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A Guest Post by Lauren Ostrowski, MA, LPC, NCC, DCC

Informed consent is arguably one of the most important parts of the counseling process and requires one of many professional documents you will need in private practice. Typically, an informed consent form is lengthy, includes a lot of different information, and is largely dependent upon ethical codes specific to a particular mental health discipline.  When your practice includes distance counseling,*  there are special considerations that must be addressed in your informed consent form.

Please note that this guest post only discusses elements of  informed consent that are unique to distance counseling and are not sufficient for your entire informed consent process or document.

My informed consent document has not been reviewed by an attorney. It was written with requirements from each of the following in mind: the American Counseling Association’s Code of Ethics (2005), the Code of Ethics for the National Board for Certified Counselors (2013), the National Board for Certified Counselors Policy Regarding the Provisional Distance Professional Services (2013), and the Online Therapy Institute’s Ethical Framework for the Use of Technology in Mental Health.

Informed Consent in Distance CounselingSounds complicated, doesn’t it?  It took me quite some time to make sure that I had satisfied all of the requirements for each of them.

General Information

Adding information related to distance counseling into an already lengthy informed consent makes it almost unwieldy.  I explain this at the beginning of my document and  specifically say that it is important for the clients to read the document at their own pace and ask questions as needed.  This guest post specifically focuses on internet counseling, as this will constitute a large majority of my client interactions. It is important to be mindful of phrasing – a lot of what is being addressed is highlighting the negative aspects of distance counseling so balance is key.

Confidentiality and Distance Counseling

Clients are responsible for the confidentiality of their own environment. (This statement constitutes its own paragraph in my informed consent because it is incredibly important).

In face-to-face counseling, the counselor can do a fair amount to make changes to increase privacy in the therapeutic environment. This is not possible when doing distance counseling. Related to confidentiality in distance counseling, you will also want to discuss the following with your client:

  • The computer and all data has potential to contain confidential information;
  • Be mindful of leaving a computer window open and moving away from the screen;
  • Consider who may have (whether authorized or not) access  to your information;
  • Be aware of the possibility of key logging software, which can be used with or without your knowledge;
  • It is recommended not to put your counselor’s e-mail in your address book so that you are less likely to accidentally send confidential information to the wrong person;
  • E-mail is not typically confidential.  The exception to this is when e-mail is sent / received through HIPAA-compliant platforms like Hushmail. Many other programs or applications may not be HIPAA compliant.
  • Verbatim correspondence from client-counselor interactions should not be revealed publicly.  However, it’s important to note that within the context of  distance counseling, this possibility does exist.  As an example, consider that a counseling e-mail could end up in a Facebook post.

Other Important Concepts

  • There may be a requirement that the client be in the same state as the counselor or in a state where a counselor is currently licensed.
  • It’s important for counselors to check with their liability insurance carriers to insure proper coverage of distance counseling.
  • Verification of client’s identity is important.
  • Some states require that clients be over the age of 18 to consent / engage in distance counseling.
  • Similar to face-to-face counseling, privileged communication does not apply when someone else is in the room.  It is important to note that this includes anyone else being around the client (for example, the computer is in living room and a family member is sitting nearby).
  •  It is common for clients to find it easier to disclose personal information faster than they would in a face-to-face session – this can be tempered by pacing sessions.
  • It is possible that a client’s privacy may be breached by a  third-party knowledge despite the fact that precautions are being taken’
  • When communication occurs in writing, it is important for both parties to be open to asking questions and receiving clarification or feedback to minimize the possibility of misunderstandings.
  • Advantages and disadvantages of distant counseling are a major component of the consent form.
  • Flexibility in client and counselor schedules is one of the biggest advantages.
  • Lack of insurance coverage can be a big disadvantage for some clients.
  • Procedures for crisis or emergency situations need to include both local and national resources.
  • Procedures to address unexpected failures in technology need to be addressed.

What other questions do you have about distance counseling and informed consent?  Did you learn anything that you could incorporate into your already existing document?

 

* Distance counseling refers to counseling that transpires through the use of technology.  
  Technology can include the telephone, texting, internet-based interactions, and others.
  Actual counseling interaction must take place in a HIPAA-compliant environment and 
  distance counselors typically have a separate website to advertise their services and 
  discuss other practice-related information that is not confidential. 

  The Distance Credentialed Counselor (DCC) is the credential is offered for mental health 
  professionals through the Center for Credentialing &Education.  The training for this 
  credential is provided through ReadyMinds and Associates.

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Image of Lauren Ostrowski, MA, LPC, NCC smaller

About the Author: Lauren C. Ostrowski, MA, LPC, NCC, DCC is a counselor in a community mental health agency in Pennsylvania.  She is also a Distance Credentialed Counselor and is excited about beginning a limited private practice using distance (online) counseling.

 

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Next Steps And Words To Live By In Private Practice

Mar
19
2014

The Journey

 

The Journey

by Mary Oliver in Dream Work (1994)

 One day you finally knew
what you had to do, and began,
though the voices around you
kept shouting
their bad advice –

though the whole house
began to tremble
and you felt the old tug
at your ankles.

“Mend my life!”
each voice cried.

But you didn’t stop.

You knew what you had to do,
though the wind pried
with its stiff fingers
at the very foundations,
though their melancholy
was terrible.

It was already late
enough, and a wild night,
and the road full of fallen
branches and stones.

But little by little,
as you left their voices behind,
the stars began to burn
through the sheets of clouds,
and there was a new voice
which you slowly
recognized as your own,
that kept you company
as you strode deeper and deeper
into the world,
determined to do
the only thing you could do –

determined to save
the only life you could save.

~~~~~

Some of my favorite clients are therapists who call needing just a little help figuring out their “next steps” in growing their private practices.

A client sent this poem to me as a “thank you” for helping her figure out her “next steps” in private practice.

It touched me and I today I want to pass it on to you today to support you on your journey, too.

If you are having trouble figuring out your next steps in private practice, I can help.

Give yourself permission to connect with someone who has been right where you are and has successfully moved beyond the hump. 

There’s more room to breathe over here and more lives to touch. 

Call me and let’s see how I can help -  303-660-4989

And, I’m wondering . . . what words  keep you focused on what you need to focus on and inspire you to change the world.  

Care to share?

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