This week an article by Sarah Lyall in The New York Times began by noting that assisted suicide

"Back to the Crazy . . . " by footloosiety / David J. Laporte

has been illegal in England for nearly 50 years. But, ordered by the courts to clarify the law, the country’s top prosecutor on Wednesday set out a list of conditions under which his office would be unlikely to prosecute people who helped friends or relatives kill themselves.”

To read the complete article, click here.

Tags: Assisted Suicide

If you are still reluctant to step into the midst of the Social Media Revolution, check out this quick video.

Then, drop me a note here and let’s talk about how this influences our work in private practice.

Tags: Social Media

Health care professionals often forget that the general public is yet another constituent of  the educational community.  As such, it is another potential focus for your marketing in an attempt to get referrals from the school system.

Research has shown that the public perception of problems faced by schools is often very different than educator’s perceptions.  That discrepancy opens up many opportunities for you to orchestrate community dialogue and related services to facilitate constructive feedback and input between these two groups.

Listed below are some of the ideas that I have collected . . . .  Some of them I’ve tried; some of them I’ve only heard about.

"Woods Waterfall Door II" by John Banks

• Hold a focus group.
• Host a town “chat” at the local library.
• Facilitate a problem-solving group.
• Conduct research on a perceived problem.
• Write letters to the editor addressing the concerns of the public.
• Start a book club that deals with education-related issues.
• Create a collaborative education-community visioning group to set goals for the school system.

What’s going on in your community?  What has worked for you? I’m sure that you have other ideas and experiences to share.  Take a minute to add your thoughts below as we begin to mine the many opportunities related to public perception of school problems.

Related Posts

Back-to-School Marketing for Your Private Practice

K-12 Support to Feed Your Private Practice

Tags: Collaborate, Letter to the Editor, School, Vision

Complete this sentence and tell me how your marketing is like a carnival.

"It's Carnival in Brazil, It's Show Time!" by xAv / Xavier Donat

Is it about the colors?

Is it about the sounds or smells?

Perhaps a personal experience you’ve had with a carnival?

Let me get this started by telling you that marketing MY private practice is like a carnival because . . .

• There’s a lot of variety in what I do to market my business;
• There are places that I like to return to over and over again;
• And, there are other little alleys that are not so comfortable for me and so I avoid them altogether.

Now it’s YOUR turn. . . .  Marketing your private practice is like a carnival because . . . ?

Tags: Red Thread

This is the fifth post in a series that highlights standardized formats for your clinical notes.  The series began here.

"Intense Color Coded Notes" by mandiberg

I have only recently stumbled across the Gillman HIPAA Progress Note here.  Of the four methods that I have mentioned, this is the only one that has been developed after the introduction of HIPAA. It was developed by Peter D. Gillman, Ph.D. in response to the implementation of HIPAA.   As such, he has taken the extra precaution to intentionally exclude information that is not protected by HIPAA.  I consider that to be a significant improvement over previous iterations of standardized note taking.

I have not yet used this method but plan to try it out.  At first glance, it seems thorough, efficient and equally important, it is fully HIPAA compliant.

If you are not satisfied with the current format of your progress notes, I would encourage you to try this one.  Here’s what you need to include:

• Time of your session,
• Treatment and frequency of modalities you provided,
• A summary that includes, client’s symptoms and functional status, progress, diagnosis, treatment plan and prognosis.

To obtain this information, Gillman recommends asking yourself these six questions . . . .

1. “What symptoms did my client present today?”
2. “How is this impacting their ability to function?”
3. “What progress did my client make since his last session?”
4. “How does this change my thinking around diagnosis, treatment, planning, and prognosis?”
5. “What is my immediate treatment plan and recommendation?”
6. “What is my immediate prognosis?”

Let me know if you try the Gillman HIPAA Progress Note and how it works for you.  I’m eager to compare notes!

Tags: Diagnosis, HIPAA, Prognosis, Record & Documentation, Treatment Plan

This is the fourth post in a series that highlights standardized formats for your clinical notes.  The series began here.

"Id, Ego, and the Misplaced Monkey" by paintMondkey / Daren Higham

A third format for clinical note taking is commonly known as BASIC SID.  This is yet another mnemonic.  The letters stand for Behavior, Affect, Sensation, Imagery, Cognition, Spiritual (and Religious), Interpersonal, and Drug (and Biology).

Behavior refers to what you see your client doing and not doing. 

Affect refers to both your client’s mood and congruence with expressing those moods. 

Sensation refers to your client’s awareness of his five senses and includes hallucinations, perceptual illusions, muscular tension or pain, excessive sensitivity to environmental stimuli, and what the client saw and heard. 

Imagery related to your client’s past, present or future in any way includes dreams, fantasies, obsessions, flashbacks and responses to guided imagery. 

Cognitive focuses on your client’s constructed meaning i.e. self talk, mental abilities, personal narrative, beliefs and mental schema.

Spiritual includes your client’s beliefs related to a Supreme Being, affiliation and practices with religious groups, religious resources, conscience and moral development, themes of guilt and forgiveness, creativity, and personal comfort related to ideas of spirituality. 

Interpersonal references your client’s relationships with others, level of social skills, degree of acculturation, and any incidents of social injustices. 

Drug and biological includes your client’s use of chemicals (both illegal and legal), medical compliance and concerns, and any incidents of delirium or dementia.

What I really like about a BASIC SID clinical note is that the acronym provides prompts to help me remember to focus on all areas relevant to my client’s progress.

Tomorrow I will talk to you about taking clinical notes using the Gillman HIPAA Progress Note.

Tags: Records & Documentation

The American Counseling Association is currently seeking a full time Director, Ethics & Professional Standards to work at our Headquarters office in Alexandria, VA.

Responsibilities include serving as ACA’s Ethics Officer and providing ethics consultation on the ACA Code of  Ethics, directing and monitoring the ethical adjudication process, advising and assisting the Chair or Co-Chairs of ACA’s Ethics Committee as appropriate, maintaining accurate and appropriate records, serving as the central resource for inquiries related to state licensure and developing materials to assist counselors in the advocacy of the counseling profession.

Requirements include a graduate degree in counseling (state license and/or national certification a plus),  experience as a practitioner and an identity as a professional counselor. Publications/presentations in the area of
ethics and professional standards are a plus.

The ideal candidate will have knowledge of the 2005 ACA Code of Ethics plus knowledge of professional counseling, licensure and reimbursement issues. You will also possess an ability and interest in helping professional counselors from all specialties and have excellent written and verbal skills, along with superior organizational abilities.

To apply send letter of application, vita, complete contact information of three references and salary history to Cindy Welch, Chief of Staff, ACA, 5999 Stevenson Avenue, Alexandria, VA 22304; cwelch@counseling.org; fax 703-823-0953.

Background checks are required. ACA is an AA/EOE organization and encourages minorities and women to apply. The position will be filled when the appropriate candidate is identified.

Tags: Ethics

This is the third post in a series that highlights standardized formats for your clinical notes.  The series began here.

"Writing Scathing Notes" by JasonRogersFooDogGiraffeBee

A second format for documenting your clinical work is called DA(R)P notes, sometimes referred to as DAP notes.  These are similar to clinical SOAP notes. 

DA(R)P is a mnemonic that stands for Data, Assessment (and Response), and Plan.

Data, in this format, includes both subective and objective data about the client as well as the therapist’s observations and all content and process notes from the session.

The Assessment and Response includes your clinical impressions, hunches, hypotheses, and rationale for your professional judgment. Progress is also noted here.

Plan refers to your original treatment plan and any response / revisions needed based on your most recent interactions with your client.

This method of clinical note taking is also an acceptable format for your documentation.

Tomorrow I’ll talk to you about BASIC SID notes.

Tags: Assessment, Records & Documentation, Treatment Plan

This is the second post in a series that highlights standardized formats for your clinical notes.  The series began here.

"Soap Carving" by Narisa Spaulding

Probably the most common form for standardizing your clinical notes is SOAP notes.  It’s likely that you learned how to document in this standardized form early on in your training as a mental health provider and you may have continued to use this format up until now.  SOAP is a mnemonic that stands for Subjective, Objective, Assessment, and Plan.

In this format, Subjective includes only the client’s subjective information.  Often this looks like a summary statement or direct quote from the client.

The Objective portion of your clinical note is observable data or information that coincides with the subjective statement.  Typically this includes the client’s body language and affect.

The Assessment is your professional and clinical judgment based on the aforementioned Subjective and Objective statements.

The Plan includes your intentions for future clinical work, any homework that was given, any referrals / interventions made, and any follow up needed or completed.

Many agencies and organizations use SOAP notes as their standard format for note taking.   Although it can be awkward and does not always easily permit the inclusion of data that you might feel is pertinent, SOAP continues to be a commonly accepted format for documentation of clinical notes.

Tomorrow I’ll talk to you about DA(R)P notes.

Tags: Assessment, Follow Up, Homework, Record & Documentation, Treatment Plan

On Monday, Brenda Bomgardner, a student intern at Regis University, wrote in asking for efficient ways to record her clinical notes.  This is the first of five posts to help you sort through your choices for clinical note taking.

"Leave Me Alone - I Know What I'm Doing" provided by foundphotoslj

You can be reasonably confident that  if you are working in an agency, the content and format for your clinical notes are already stipulated.  However, for those of you entering private practice, you have more leeway in deciding what your client notes, often called “progress notes“,  will look like.

All mental health disciplines require documentation of your clinical work.  Although the required content for that documentation varies from discipline to discipline and from jurisdiction to jurisdiction, there are general categories of information that are required for you to keep in your records. These categories typically include contact information, your client’s presenting problem, your assessment, treatment and plan.

In addition to free form notes, there are at least four common ways to standardize and record this information.  They are:

• SOAP Notes,
• DA(R)P Notes,
• BASIC SID Notes,
• and Gillman HIPAA Progress Notes.

Next week, I’ll share with you how each of these differs.  Then you can decide how best to keep your own clinical notes.

Do you know of other formats that you like to use?  If so, please share them with us here so that we may all learn from you!

Tags: Assessment, Record & Documentation, Treatment Plan

In July, I talked with you about using professional online discussion lists to build your business.  Participating in online discussion groups that target your unique interests can also build your reputation and credibility.  Here’s an example . . . .  I am a member of a discussion list that focuses on women in Colorado who are in different aspects of the media business.  Because I responded to someone else’s inquiry about when to turn away business in this less-than-ideal economy, I ended up being quoted here in Drea Knufken’s blog, Business Pundit.  Twenty-four hours later, I was quoted here in Steve Tobak’s blog, The Corner Office.

"Smooth Peace 2" by Exper Giovanni Rubaltelli

If your marketing plan includes expanding your visibility or building your reputation in the community, here’s how to make that happen:

• Take some time to make a list of your unique interests . . . genealogy, bird watching, writing, football, etc.
• Google your interests along with the words “discussion list.”
• Check out what comes up.  If you find discussion lists that interest you, join them and share.
• If you don’t find a discussion list that fits your interests, then consider creating one of your own through Google Groups or Yahoo Groups.

Your interests do not need to be directly related to mental health (although they could be) in order to help you create greater visibility.  Once you become active in an online discussion list, your professional interests and expertise will gradually become known.  Like face-to-face networking, your online relationships will also take time and commitment from you in order to achieve the goals that you desire.

Give it a try! Then check back in here to let me know what you tried and how it’s working!

Related Post

Professional Online Discussion Lists Deserve Your Attention

Tags: Relationships, Reputation

True wealth is abundance that does not create scarcity.

- Rabbi Nilton Bonder interpreting The Talmud
in The Kabbalah of Money: Jewish Insights on Giving, Owning, and Receiving

Tags: Abundance, Scarcity, Wealth

For those of you who are new to the health care professions and take advertising for granted, you might be surprised to learn that not so long ago advertising was considered to be unethical for many health care professionals.  Last month John Riolo, Ph.D. was writing on the Counselors at Yahoo discussion list about the controversial history of advertising in the mental health professions.  He noted that it took the Federal Trade Commission stepping in before social workers were allowed to advertise!

If you are considering print advertising as part of your overall marketing strategy, here are a few things you will want to consider before you hand over your money:

• Whether you are taking out a listing in the phone directory, the local paper, or a program for a community event, actual placement on the page matters.  Research has shown that ideal placement for your ad is in the upper right hand corner of the right hand page.  That’s where our eyes normally travel first and linger longest (in cultures where we read from left to right, top to bottom).

On the rare occasion that I purchase advertising I always ask for that choice position.

When dealing with less sophisticated staff for advertising, they often accomodate my request at no charge.  However, those that are more informed about the advertising services being offered will typically charge me a surcharge (maybe 10% more) and I am always happy to pay it because I know it will be seen and read more often.

• For advertising to be effective in a newspaper or similar recurring publication, it must be seen repeatedly over time.  One shot advertising is rarely effective.  In order for your ad to work for you, you will need to advertise over a prolonged period of time at a predictable frequency i.e weekly or every other week.  The reason for this is that it is unlikely that readers will need your services on the very day the newspaper comes out.  However, if they see your ad every other week (in the same upper right corner of a right hand page), they are more likely to remember you when they are in need of your services.  If you can’t afford the recurring ad, then consider other options for marketing your practice.

• The exception to the above, is if you are advertising in a program for a community performance or charitable event like The Turtle Creek Chorale or Swallow Hill.  Of course, taking out ads for the entire season will still be more effective than a one time deal.  However,  if your budget doesn’t allow for the recurring ads, you may still find these community-based niches to be more closely read as well as more loyal patrons.
• Another way to tap into the patrons who are loyalty-driven, is to advertise within a specific subculture. This could be a religious community, the transgender community, or even a 12-step community.  Any group that tends to feel marginalized by the dominant community can be a more effective focus for your advertising.

So now that I’ve given you some strategies to maximize your advertising dollar, where will you decide to spend them?

Related Posts

Clinical Supervision and Money Gouging

10 Questions You Must Ask Your Potential Supervisor

9 Steps You Can Take to Insure a Great Supervisory Experience

Tags: Ethics, Newspaper, Niche, Phone Directory, Subculture

Have you seen this article in the New York Times by Vincent Malozzi, Answers to Life’s Worries, in 3 Minute Bursts?  Once you read the article, drop back in and let me know what you think about this out-of-the-box idea.

Tags: Appointments, Out-of-the-Box

I received a call this week from a counselor who has recently moved into Colorado.  She asked if I could provide clinical supervision for her post-graduate work.  As we explored that possibility, the conversation turned to her previous experiences with clinical supervision and they were less than ideal.

If you, too, find yourself tempted to settle for a less than ideal supervisor, you are in need of a supervision rescue. Here are some ideas to consider. . . .

There is NO correlation between being a good therapist and being a good clinical supervisor.

Although the knowledge bases overlap, they require decidedly different skill sets.  Teaching, training, and monitoring are necessary for clinical supervision but are not the tasks of a counselor. Thus, the trend to require supervisors to have formal training in supervision.

Poppy Love . . . . #4 -- squaRED by onkel wart / Thomas Lieser

Mental health professionals are trained to initiate and facilitate difficult conversations.

This may be the perfect opportunity for you to discuss and re-negotiate your supervision with your current supervisor.  Perhaps she was unaware of your interest in clinical supervision and is willing and able to change how she supervises you ; or, perhaps she is not skilled in clinical supervision and can help facilitate a transfer for you to work under someone different who provides clinical supervision.  

Be clear about what you want / expect / need and ask for it.

Some therapists find that it works better to get clinical supervision from someone other than their immediate supervisor at work.

What you may not have realized is that if your boss may be functioning as  your administrative supervisor AND your clinical supervisor.  If so, at least some of the time, it is likely that she will have conflicting/dual roles.

You can’t always speak openly about mistakes that you’ve made with someone who has the authority / responsibility to fire you.

Many organizations are open to contracting with an independent  licensed mental health professional to provide weekly clinical supervision to their employees as an employee benefit.

This supervision may be provided to a small group, to you individually, or in some combination of the two. An organization can contract for this supervision at a much lower fee than if you seek out private supervision on your own.  

If your work site does not currently offer this type of supervision, perhaps it’s time to do a little reconnaissance work and then pitch the idea to them.

Related Posts

Clinical Supervision and Money Gouging

10 Questions You Must Ask Your Potential Supervisor

9 Steps You Can Take to Insure a Great Supervisory Experience

Tags: Change, Contract, Dual Roles, Mistakes