Setting Up Services: Supervision versus Consultation

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When thinking about services you want to offer in your business, it’s not unusual to explore offering both consultation and supervision as part of your mental health leadership. In fact, it’s a common question I get when supporting fellow supervisors and leaders who are building their brands as professionals. So let’s take a look at the opportunities and differences between consultation and supervision as you consider offering these valuable services in your work with others.

Clinical Supervision can be defined as a licensed mental health professional supervising an unlicensed or candidate mental health professional in their therapeutic work as they pursue licensure. Some things to note:

·      Supervision must be scheduled regularly per your licensing board

·      Supervision requires contract of expectations for both supervisor and supervisee

·      Supervision comes with liability for the licensed professional taking on an unlicensed professional until they achieve their own licensure

Professional Consultation can be defined as a written and/or verbal agreement to provide insight, suggestions, and resources to a colleague who is paying for your expertise. Some things to note:

·      Consultation can be scheduled as a one-and-done or as needed basis

·      Instead of a contract, there is a written agreement about the parameters of consultation including fees, duration, and specialities the consultant can speak to.

·      Consultation, as a professional service, has reduced liability similar to paying for a product. The consumer—in this case a colleague—agrees to a fee for your knowledge and expertise to support their goals.

So how can this look different when a fellow mental health professional outreaches you?

Consultation requests may sound like:

·      Can I pick your brain about building a group private practice?

·      Can I schedule consultation with you on a client’s OCD presentation and next steps?

·      Can we find a time to talk about suicide prevention resources in Colorado?

·      I’d like to staff a case with a recent DV incident, how do I schedule with you?

Supervision requests may sound like:

·      I’m seeking a supervisor who specializes in EMDR and Play Therapy

·      I’m looking for a supervisor who can support my clinical work outside of my agency that offers admin supervision only

·      I’m searching for a LAC supervisor to sign off on my hours

·      I’ve recently graduated and am seeking a supervisor as a I start private practice

Although an evaluation of appropriateness of supervision vs. consultation is encouraged at every outreach, knowing the context of what you can offer is a valuable first step when receiving an inquiry from your community. I hope this brief exploration of the differences in what you offer under each umbrella can help you in setting up your services with confidence!

Taking on Private Insurance is Like Learning to Eat Healthy

Taking on private insurance is like learning to eat healthy.

At first you aren’t sure you want to do it. You’ve heard how hard it can be and so you’re on the fence. You enjoy your freedom and don’t want to be tied down by all the rules. It seems like so much effort. It feels too hard.

But there’s this little voice in the back of your mind saying what if? What if eating healthy could be the best thing for you in the long run? So you take the first steps in learning to eat well. You find yourself frustrated with the effort, energy, and resulting mood swings that come from being outside your comfort zone. You continue to question if it is worth all the hassle. You have a couple meltdowns.

Eventually, with persistence, you find your groove. You’re noticing it takes less effort to eat healthy. You’ve found success in having a plan in place, it feels more effortless now. 

The journey of adding insurance to your private practice is a lot like learning to eat healthy. 

The same emotional rollercoaster. The same doubts and frustration. The same growing pains. And in the end, insurance can contribute to the overall health and well-being of your business, allowing it to thrive amidst COVID-19 and beyond.

 So let’s take a look at some of the myths and practical tips to navigating insurance in private practice.

Myth #1: The Panels are Closed

It’s possible that the panels are closed, especially when we understand that insurance data on their providers isn’t very accurate or up to date. It isn’t uncommon to hear that providers listed in directories are retired, deceased, or not taking new clients. So how successful would a member (client) be in finding a qualified provider?  Encourage potential clients to reach out to their private insurance to express their concerns and difficulties. Sometimes this works to open up a panel for credentialing of additional providers in hearing that their members can’t find the services they need.

What can you do as a professional? 

·      Name your Niche: Highlight your specialties and justification for being approved as a provider. If insurance finds you are providing a service their members want, they could agree to move forward with credentialing.

·      Be Persistent: Follow up with closed panels to see if things change over time. Your persistence may pay off if you catch them in the optimal window where they are taking new providers!

Myth #2: Payment is Poor

I recommend to fellow providers that we all find a way to make peace with not being paid what we are worth. Insurance panels will report that they generate their pay structure based on comparable professionals in your area and thus, believe they are offering a competitive rate. Regardless of what they pay, is it still important to you to serve a particular population? Is it worth the effort to help people who need to use their insurance to access services? If you’ve answered yes to these questions, don’t give up on insurance just yet! Panels continue to evaluate rate of pay on an annual basis and I’ve seen the rates of reimbursement improve over time. There’s hope that they will continue to evaluate and increase rates every year.

Professional Pointers

·      Do your Research: What services does each insurance panel reimburse for and at what rate? Interview colleagues to better understand their experiences with certain panels.

·      Renegotiate as Needed: Identify the process for renegotiating your rates once you’ve been credentialed as a provider. It doesn’t mean you will automatically get what you’re asking for but it could spur insurance to take another look at rates for all their providers in hearing from you and others that a rate increase is desired.

 Myth #3: Billing is Unbearable

I agree with you that billing can be a headache. More so when we had to mail in claims or submit them by hand on CMS1500 forms. The good news is that billing has been streamlined, saving time and headaches for providers everywhere! What has streamlined billing over the past ten years? Electronic Health Records (EHR). Popular options like SimplePractice, TherapyPartner, and TherapyNotes have billing processes built in, eliminating the middleman clearing house and auto-filling some billing information based on your calendar appointments to save you both time and effort as a busy clinician.

Professional Pointers

·      Create Templates: Streamline your process even further by creating required templates in your EHR like a credit card form for collecting copays and a Mental Health Assessment to justify a clinical diagnosis required to bill each service.

·      Understand Compliance: Identify compliance requirements based on your insurance contract. Most require a diagnosis resulting from a formal intake, progress notes, and treatment plans for providers to remain compliant and pass an audit.

Myth #4: I’ll End Up Working for Free

There is understandable fear that clinicians could work for free. Insurance panels could take money back if providers make a billing error or if the member isn’t actually covered by an active insurance policy at the time of service. Combine this with confusion about what insurance plan the member/client actually has and the random names for varying plans under bigger names like Aetna and United, it’s no wonder providers feel reluctant to jump on the insurance bandwagon. It’s in your best interest to create a system and process for verifying insurance from the first contact with a client you’d like to work with. It is also in your best interest to bill regularly so you can catch any errors in a timely fashion. After all, it’s even more painful to realize you aren’t getting paid for the last three months in having waited to bill sessions at a later date. 

Professional Pointers

·      Anticipate Delays: Budget your business with anticipation of delays in payment. Most insurances take 2-3 weeks to process claims.

·      Set up EFT: Selecting Electronic File Transfer (EFT) or Direct Deposit of funds will save you some stress in seeing when funds are processed and received in your business account

Insurance doesn’t have to be so stressful. I sincerely and passionately believe that adding insurance clients to your practice will support sustainability and quality client referrals, making your business a healthy one full of growth and long-term potential in offering what you do. 

To learn more about adding insurance to your private practice, check out our webinar, Investing in Insurance: Strategies for Private Practice which features more on the 4 Myths and 20+ Tips of adding insurance to your private practice, making it work well for you!

Geared towards Growth: Exploring Maslow’s Hierarchy of Needs

Have you had a client come into your office wanting to work on their relationships? What about a client who wants to work on self-worth and self-esteem? These goals are valuable and achievable, and could greatly benefit your client in their functioning and connection in the world.  However, depending on your client’s stressors and current life events, basic needs may need to be attended to first in order to achieve the growth and progress desired within your therapeutic work.

Hierarchy of Needs

Abraham Maslow first introduced the concept of a Hierarchy of Needs in a paper published in 1943. The image found most often in reference to his concept is a pyramid with the bottom representing the building block or foundation for higher functioning. According to Maslow, every human being has needs that must be met and stable prior to advancement to another level of human need. The levels he identified begin with physiological needs, followed by safety needs, love and belonging, esteem, and finally, self-actualization. Below are some examples of needs for each level:

• Physiological: food, water, oxygen, sex, sleep, excretion
• Safety: security of shelter, employment, resources, health, body
• Love & Belonging: family, friends, intimate partners
• Esteem: confidence, self-esteem, respect by others, respect for self
• Self-Actualization: Acceptance, lack of prejudice, enlightenment

Goals for Growth

So how do the levels of need impact your client’s therapeutic work? For many helping professionals, the awareness of the hierarchy manifest through client psychoeducation around basic needs. Perhaps your client wants to work fully on their relationships, but is impacted by the stress of not having a job to pay their bills. Maybe your client wants to strengthen self-esteem, but can’t identify housing in suffering from an eviction this month. The present crises will require therapeutic attention and intervention first prior to a client allotting mental energy to higher levels of functioning.

Within your work, it can be helpful to normalize and educate your clients on basic needs being the foundation for functioning. You may consider describing the imagery as basic needs being the foundation of a house. If the foundation is crumbling, the other parts of the house become low priority or unseen in trying to stabilize the problem due to risks of it all collapsing around them. With this analogy, clients can absorb the importance of a stable foundation of basic needs requiring their attention before other goals can be successfully met.

Accessing Needs

A stable foundation may require other resources outside of your office. As a helping professional, it is in your best interest to be aware of resources to provide additional support to your client. The databases in your state, (Colorado Crisis Services and Colorado 2-1-1 for example) can be helpful in identifying food, shelter, clothing, legal advice and more.  You may also consider coordination with helpful organizations that would warrant a release from your client in order to collaborate.

Assessing needs can also occur from a place of looking at client resistance. One way this may manifest is through your client’s capacity to work on homework or assigned tasks between sessions.  Although some clients don’t like homework out of personal choice, other clients may struggle to articulate the crises that prevent progress on the homework you assigned, including forgetfulness, loss of focus, or stressors demanding their attention instead. This attempt at juggling varying demands could even translate to cancelled sessions in trying to handle the stressors at home or work. By being aware of basic needs, it can help you as the professional to better understand contributing factors that may present like resistance as elements requiring attention to support client progress.

Maintenance and Motivation

With collaboration and stabilization of basic needs come the client’s motivation for maintaining the foundation.  It is the hope that client’s basic needs, once addressed, remain in good standing.  However, with clients experiencing poverty, trauma, or other adversity, the fluctuating circumstances of their life can delay progress on higher functioning goals. Encouraging ongoing boundaries and self-care can support the client in reaching higher goals around self-esteem and relationships. With awareness and effort, a client can harness a healthy sense of control and autonomy in their life. Remaining flexible to the stressors that may occur between sessions, it is important that you and your client continue to be mindful of what takes precedence to allow the deeper, meaningful work you both value to occur at the appropriate time.