Oh, Yes, You ARE! On Call 24 / 7

Nov
9
2011

Image of Help Me HandsMy colleague, Bonnie Goetz, MA, LPC, NCC  wrote in on the Denver Therapists Network online discussion list asking for help .  Having just had this conversation earlier this year in my Peer Consultation and Supervision Group, I asked her if I might address it here on my blog so that others can join the discussion.

Here’s what Bonnie wrote . . . .

I am wondering if anyone out there . . . has found a good way to offer the mandated 24/7 coverage other than being constantly strapped to a cell phone? I know some people use answering services, but from what I understand the service would call the therapist directly in case of emergency anyways.

I would really like to be able to turn off my cell phone at the end of the day, but have not been able to figure out a way to do this and still be in compliance with my [insurance] contracts. Generally I handle this by not taking clients who have high needs between sessions, but I still get the occasional call from people on the weekends or evenings, and I hate checking my phone all the time!

Any thoughts or suggestions would be greatly appreciated!”

Yep, I have a few thoughts and suggestions, Bonnie.  Acts of omission, such as not returning phone calls in a timely manner, are definitely grounds for a malpractice suit.  I’ve heard attorney Bart Bernstein, J.D., LMSW refer to this particular situation many times in his workshops on ethics and counseling.  The example he gives is this . . . .  If a client calls you and gets your answering service or, worse yet, gets an unanswered phone . . . and you as his therapist are the only person the client feels like he can talk to about a particular issue / crisis . . . and you fail to return the phone call in a timely manner i.e. within 24 hours . . . , you have, in effect, abandoned your client.

That’s why your question, Bonnie, is such an important one.  Some therapists believe in error that being available 24 / 7 is stipulated by a particular managed care company.  And, while that may be true, the bigger picture is that your professional associations, your licensing board, and your state laws are also likely to be requiring the same thing – that licensed mental health professionals must respond and be available to clients in a timely manner.

For those reasons, here’s a few of the ways that you can responsibly, ethically, and legally take care of your clients’ needs while also taking care of your own needs, too.

  1. Trade off with another trusted colleague.
  2. Use a professional answering service.
  3. Hire a virtual assistant or office manager to manage the initial contact with your callers.
  4. Consider using a paging system.
  5. Forward calls to another licensed mental health professional.
  6. Create a call group of licensed mental health professionals.
  7. Provide a code word for clients to use when they call in case of a crisis.

Or, you can choose to cover your own phone calls 24 / 7.  Just remember that you are ultimately responsible for that coverage.  If you have someone else covering for you, make sure that s/he is competent and trustworthy.  Your clients’ lives, your own reputation, and your own licenses are on the line.

If you have found other ways to meet your clients’ needs 24 / 7, I hope you will take a moment to share with us here!

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8 Reasons To Work In A Community Agency BEFORE You Go Into Private Practice – Part 2

Nov
2
2011

This is the 2nd part of a 3 -part series.Image of Number 8
To see the previous post in this series, click here.

The Clinical Experience Will Be Invaluable

By working in a community mental health agency, nonprofit organization, or psychiatric hospital after graduation, new mental health professionals can learn to work with a wide variety of clients and issues.  This strengthens your clinical and diagnostic skills.    Oftentimes, the clients you see in these settings will have fewer resources and a greater number of social and clinical challenges.  That’s an experience that is unique to these community settings and will help prepare you to competently work with a variety of presenting issues.

Professional Development is Usually FREE

Every mental health professional is ethically obligated to continue their professional development throughout their careers.  Even Colorado has finally stepped up to this standard!  One of the best things about working in community settings is that continuing education is typically provided for employees on the job at no additional expense. Consider that the typical workshop or conference that I attend may cost me at least $15-20 per hour without counting transportation and lodging.  That’s a a great deal and a huge incentive for the new professional!  Think about it – If your state requires that you attend 24 hours / 2 year cycle like Texas does, that equates to $480 / 2 year cycle plus transportation and lodging. If that training does not come as a perk from your employers, then it’s coming out of your paycheck!

Peer Consultation is Right Down the Hall

Most mental health professionals in private practice are sole proprietors who work in offices isolated from their peers.  The number one complaint I hear from them is “It’s lonely in private practice!”  By working in a community setting, you have an opportunity to work with and learn from your colleagues right down the hall from you.  When you have a clinical or administrative question, you will have peers an arms’ length away to staff a case or help you find resources.  Once you are out on your own, that immediate availability is likely to be much more difficult to find.

Shared Liability Reduces Your Risk

When you work as a therapist in a community mental health agency, it’s likely that you will make your share of mistakes just like the rest of us humans do while we are learning new skills.  The benefit of making them there is that should you encounter a disgruntled client that decides to sue for malpractice, your entire agency can rally to your defense.  Once you are in private practice, you are all on your own!

Administrative Supervision is Free and Abundant, Too

OK, so I’ll admit it . . . .  I rarely appreciated administrative supervision when I had it. Mostly, it seemed like a lot of red tape i.e. a pain in the butt.  Nevertheless, after 30 years of working in the field of mental health, now I get it.  I get how critical it really is to learn early on how to write a strong progress note and treatment plan, how to deal with money matters and cancellations, and how to set an appointment, and how to be a team player in an organization.  And, equally important, I get why someone needs to make sure that an agency continues to meet their own goals just to survive.  Administrative supervision is critical – to the agency, yes, but also to you as a new professional.  Administrative supervision teaches you to put foundational habits and practices in place that will support you in the field of mental health for decades to come.

Clinical Supervision at No Additional Cost

No one told me when I entered graduate school that I would need clinical supervision post-graduation in order to get licensed and practice ethically and competently.  And, when the topic eventually came up . . . in my Practicum class, no one bothered to spell out that in all likelihood it would be ME paying for every minute of that supervision unless I had an employer or tooth fairy that was willing to provide it to me at their own expense!

If you were as clueless as me, let me clue you in now . . . . The customary fee for clinical supervision post graduation can easily cost you an additional $30,000. Here are some more thoughts about fees for clinical supervision.  However, for now, let me just say that if that’s coming out of your wallet right out of graduate school, it’s going to hurt! Many employers will provide individual and / or group clinical supervision at no additional cost to you.

Community Resources Abound in Agency Settings

One of the challenges to any new mental health professional is a general lack of knowledge about the community resources.  Yes, many communities have a “Blue Book” of community resources but that is not sufficient to support your clients and minimize your liability in private practice.  By spending time in an agency, you will have time and experiences that allow you to develop a knowledge and understanding of specific agencies’ strengths and challenges.  For example, if you were in private practice today, would you know

  • How to support and keep safe a suicidal client who has phoned you? (Check out ASIST through LivingWorks.)
  • Where to send a client who is struggling with staying sober? (Inpatient treatment if detox is needed; Alcoholics Anonymous for ongoing peer support.)
  • Who provides group therapy to court-ordered domestic violence offenders? (Here in Colorado, providers must be approved through the Domestic Violence Offender Management Board.)
  • Who to call first when you’ve been threatened with a lawsuit? (Yes, call a mental health attorney.)
  • Where to turn when your client needs resources to help her adult son who is soon to be homeless? (For me, it’s the Douglas County Youth Initiative’s resource guide.)

Of course, those questions are just a fraction of the resources that you will need to know in private practice.  And, working in an agency for a few years will build up your knowledge of community resources faster than anything else!

Opportunity Foster Community Relationships Will Pay Dividends Down the Road

And, while you are building up that knowledge of community resources, you will also be building up your address book as you continue to meet and problems solve with other agencies and professionals in your community.  You may see this initially as simply “doing your job.”  But, the truth is, you are planting seeds!  Once you leave the agency and move into private practice, you will see that you have fostered many relationships with individuals and organizations.  If you’ve done this right, you will know many who can and will be eager to send clients to you for counseling and support!

Here, in Colorado, many new therapists eschew agency work and opt to immediately hang out their shingles only to find that they struggle.  I can’t say that I’m really surprised. If you haven’t planted the seeds to help clients find their way to you, it’s not likely that you will have great success in private practice.  There are many paths to building a successful and vibrant practice, but working in an agency is definitely one that can pay off in dividends if you have the wisdom to pursue it!

Have you worked in a non-profit or agency of some type?  What has been the benefits for you?  Are you now in private practice and didn’t take this route?  I hope regardless of your path, you’ll take a moment to drop in here to chat and let us learn from your journey, too!  I look forward to chatting with you!

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8 Reasons To Work In A Community Agency BEFORE You Go Into Private Practice – Part 1

Oct
31
2011

This is the 1st part of a 3 -part series. Image of the Number 8

Dorlee M, in New York blogs on Social Work Career Development.  Earlier this year, she wrote in asking why I have have repeatedly stated that working in a community agency (nonprofit, hospital, or organization) is the smartest thing a new graduate can do.

Here’s 8 reasons why I believe new mental health professionals (and coaches) should spend at least 3-5 years gaining their clinical sea legs before stepping out into private practice.

  1. The clinical experience will be rich.
  2. Professional development is usually free in a community agency.
  3. Peer consultation is right down the hall.
  4. Shared liability in an agency reduces your risks.
  5. Administrative supervision is free and abundant in a community agency.
  6. Clinical supervision at no additional cost will position you for greater success with your clients.
  7. Community resources abound in agency settings.
  8. Opportunity to foster community relationships will pay dividends down the road.

Not sure what I’m talking about?  Check in on Wednesday for Part 2 of this post as I explain. And, if I’ve left off other benefits to working in a community agency, feel free to add them below!


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When Your Counseling Client Bounces A Check . . .

Aug
4
2011

Have you ever had a client pay you with Image of Paying the Billsa check and then it bounced?  And, then the client didn’t show up again for an appointment?  Nor does he answer his phone calls or emails?

I get this scenario presented to me all the time from mental health professionals . . . typically followed with the question “What should I do?”

If it hasn’t happened to you yet, it’s only a matter of time before part or all of this scenario shows up in your office, too.  Here’s what I suggest . . . .

If the Check Does Bounce . . . .

  • Call your client (if you have permission to do so) to immediately discuss the matter.  It’s possible that it’s just a banking error and your client may be grateful to learn about it.
  • If you cannot reach your client on the phone, send a letter to the client with a copy of the check enclosed.  Ask him / her to issue another check to you or call the office to make other arrangements.

When No Phone Calls or Emails are Returned . . . .

  • It’s possible that your client has terminated with you – albeit not in the manner that you would have preferred.  He or she may never have felt like it was a good “fit.”  Or, s/he may be embarrassed about the bounced check.  Or, there may be another reason altogether.
  • What’s important for you to do is to remain ethical and legal at all times.  Before you consider pursuing a financial debt, you need to consider whether or not you have the legal and ethical authority to do so.  Yes, as a business owner, you have the right to pursue a debt owed you.  However, as a licensed mental health professional . . . you may not have that authority because attempting to collect a debt may be viewed as placing you in a dual role that is not in the client’s best interest.
  • When in doubt, consult with your more seasoned colleagues and the advice of a mental health attorney.  Don’t just assume anything.

If / When Your Client No Shows . . . .

  • You have a bigger issue than just money if your client fails to show up for another appointment.  Now you need to consider your client’s welfare, too – regardless of any debt owed.
  • Given the circumstances that you are aware of, you may need to contact law enforcement to request a “welfare check” or enlist the aid of a family member.  Make sure you take this step exactly as your particular jurisdiction requires.  You do not want to over-step or under-step.  The consequences of either could be devastating to both you and your client.

I know it is frustrating . . . especially for newer professionals . . . to have so many gray areas in our day to day practice.  That’s why it’s important to acknowledge that we get paid, in large part, to make judgement calls all day long every day.  There’s not a way to get around it.  And, when our clients don’t play by the rules that we’ve established, you can be sure that you’ll be required to make at least one or two judgement calls.  In my mind, it’s part of what justifies our fees . It’s why we earn “the big bucks.”


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Disaster Planning For Your Private Practice

Jul
18
2011

Whether you are just starting your private practice or you are a seasoned professional, you and your office are not immune from fires, floods, earthquakes, tornadoes, tsunamis, volcanoes and other natural disasters.  That’s why I’ve invited Julie Uhernik, RN, LPC to guest post today.

______________________________

A Guest Post by Julie Uhernik, RN, LPC

(If you want to guest post on this blog, check out the guidelines here.)

Natural Disasters

This year has seen an unprecedented number of natural disasters which have affected thousands of lives either through direct experience of disaster or through collective knowledge of and concern for the many affected. The response of counselors to assist disaster survivors has been tremendous. Many counselors have partnered with the Red Cross and other disaster relief organizations to bring mental health assistance to survivors, their families and fellow responders.Image of Pop Nature

Professional organizations such as the American Counseling Association (ACA) have made Disaster and Trauma Response a primary area of focus, assisting counselors to obtain knowledge and information on best practices in this rapidly emerging field.  However, one important consideration that has not received quite that same amount of attention is a professional’s response to a disaster that directly impacts the counselor and their clients.  To put it simply . . .

  • What will you do if your office is destroyed by a tornado or hurricane?
  • Have you made provisions  for your practice or agency in Counselor Professional Preparedness Planning?
  • Does your agency or practice have a plan in place should the unthinkable occur?
  • What do you need to do to protect your clients, your family and your greatest counseling asset…yourself?!

Standards of Care

The Center for Disease Control and Prevention** recommends that we all  “Get a Kit, Make a Plan and Be Informed”.  The newly revised ACA Code of Ethics Standard C.2.h. (Counselor Incapacitation or Termination of Practice) requires a transfer plan to be in place to assure that clients have access to both counseling and their records during the period of time in which you are unable to provide counseling services. This standard would presumably include therapists whose offices / agencies were destroyed in a disaster.

It is recommended that your Professional Preparedness Plan include:

There are many important things to ponder before a disaster occurs.  As a counselor, are you ready?

**See PDF file Adapting Standards of Care under Extreme Emergencies

_______________________________

Julie Uhernik, RN, LPC offices in Parker, Colorado.  She specializes in disaster mental health and trauma and provides consulting services related to emergency planning and response. If you would like to contact Julie, you may reach her at http://www.JulieUhernik.com.


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