Pivoting in Practice: How to Embrace Business Change within a Pandemic

We’ve been riding the rollercoaster of this pandemic for months. It’s almost hard to believe. We can’t even begin to fathom the full results of this event and the impact on our businesses. As therapists, we know we must fortify ourselves for the mental health crisis that comes with COVID-19. As a colleague, I’m hearing that we are burning out, stretched too thin by grief, anxiety, and tragic loss. In the grand scheme of things, this means we will need more mental health professionals to carry the load. It also means therapists are maintaining smaller caseloads to allow for self-care in the face of overwhelm. As business owners, we are clenching our muscles and leaning in. As entrepreneurs, we are rallying. Now is the time for pivoting and planning. Months into COVID-19, we are looking for ways to pivot to allow our practices and businesses to not only survive, but thrive.

Planning to Pivot?

Pivoting is a term in business for shifting gears, changing direction, and/or finding new focus. As private practice owners, we get the opportunity to pivot in order to address life’s changes and challenges in ways we feel are a good fit for our business. For some of you, pivoting means:

·      Offering telehealth

·      Providing webinars

·      Speaking online

·      Developing online coursework

·      Writing blogs or a book

·      Identifying a secondary income stream

It can be exciting to start new endeavors, and it can also be challenging. Let’s recognize that creativity can feel limited when other responsibilities require your attention and stress levels are so high that they may hurt your ability to focus. You don’t have to do this all in one shot. You don’t even have to do this alone. Here are some ideas to help you move deeper into a creative mindset to better your business.

Schedule Time for Creativity

That’s right. Put it in your calendar. Where can you find time to work ON your business rather than in it? Can you map out time for brainstorming? Writing? Course creation? Conversations with other inspiring entrepreneurs? I too have learned that if I don’t schedule it, it doesn’t happen!

Move your Body

Have you ever noticed that some of the most brilliant minds are depicted as pacing in movies when trying to figure something out? There is a reason for that! Movement allows deeper processing, especially when it’s a repetitive, low-energy motion like walking or pacing. So get outside and take a walk, allowing your mind to mull over the possibilities at an easy pace.

Remember your ‘Why’

No matter where you decide to take your business, be sure to slow down enough to check in on your ‘why.’ Does this new endeavor support your values and brand? Does it support your mission as a person and as a professional? Carry a notebook and write down ideas as they come to you. Run new ideas by a trusted colleague or friend to see what they think. 

Invigorating Investments

For many entrepreneurs, if the pivot aligns with their business, it can feel both exciting and invigorating to have a direction to go and plan of action to take.  You see, entrepreneurs enjoy building and creating and they feel much more emotionally invested when creating something new or worthwhile. I hope that you too can experience the excitement (dare I say giddiness?) of pivoting in your practice to support your mission, vision and brand. Check out my book Perfectioneur: From Workaholic to Well-Balanced launching June 1st for other ideas on how to thrive as a driven entrepreneur. I can’t wait to see what you create!

Supervision Success: Leveling up with the ACS Credential

Supervisors are taking their role to the next level with the Approved Clinical Supervisor (ACS) credential. As mental health professionals continue to expand on their therapeutic skills and advance within their profession, it’s becoming more common to see an emphasis placed on training and preparation when identifying yourself as a clinical supervisor in the field. 

Gone are the days of working in the field for “x” number of years to justify your readiness to mentor and supervise others. With the complexities of supervision including liability, responsibility, clinical competence, ethics, and brand recognition, agencies and organizations are sending supervisors to additional training to assist them in growing into the role of supervisor in ways that are both ethical and empowering. Private Practice clinicians are also offering their services as supervisors when focusing on niche populations or specialties. Therefore it’s important to take a closer look at the ACS credential and how it can help your professional goals.

What is the ACS Credential?

The Approved Clinical Supervisor (ACS) Credential* requires a total of 45 clock hours of clinical supervision training specific to providing clinical supervision or becoming a clinical supervisor, which must include each of the following content areas:

1.     Roles and functions of clinical supervisors

2.     Models of clinical supervision

3.     Mental health–related professional development

4.     Methods and techniques in clinical supervision

5.     Supervisory relationship issues

6.     Cultural issues in clinical supervision

7.     Group supervision

8.     Legal and ethical issues in clinical supervision

9.     Evaluation of supervisee competence and the supervision process

There are several organizations and entities that offer trainings that meet this criteria. Supervisionary is one of them, with bolded items above fitting both ACS training requirements and Supervisionary’s 4.0 CE Hour, NBCC Single Program Training titled: The Empowerment Model of Clinical Supervision**

What’s required for the ACS?

In addition to training content, the ACS candidate must submit proof of:

1.     A minimum of 100 hours of supervision, to be endorsed and signed off by licensed mental health professional with supervision experience. 

2.     Have 4000+ hours of mental health experience post masters or doctorate degree with proof of licensure

3.     Professional Disclosure Statement

4.     Transcript from master’s level or higher education

5.     Application fee

All of these items would then be submitted as part of your application in order to be considered for the ACS credential, awarded by Center for Credentialing and Education (CCE). ™ 

Where do I get training?

The CCE website includes a directory of Approved Continued Education Providers (ACEP) through NBCC that can be of assistance when finding training in supervision, including university programs and private entities offering workshops or trainings face-to-face or online. 

Check out the ACEP directory to find trainers at: https://www.nbcc.org/search/acepdirectory

Maintaining your ACS Credential

If you’ve already completed the initial requirements for your ACS credential, congratulations on joining the ACS professional community! You know the next step in celebrating your commitment to quality supervision is maintaining good standing. ACS credentials are renewed every 5 years and must include 20 hours of continued education specific to supervision. Therefore we hope you’ll consider Supervisionary once again for further training or material focused on supervision to enhance your skills!

To engage Supervisionary in our 4.0 CE hour training, please visit www.empowermentmodelsupervision.com or email us at empowermentmodelsupervision@gmail.com

Congratulations on exploring the next step of your professional journey by considering “leveling up” as a clinical supervisor! We are confident you will find the experience as engaging and rewarding as we do and we look forward to bringing the community together through meaningful trainings and quality materials!

Written by Khara Croswaite Brindle, MA, LPC, ACS

*As noted by CCE at https://www.cce-global.org/credentialing/acs

**The continuing education program "The Empowerment Model of Clinical Supervision" has been approved by NBCC for NBCC credit. Supervisionary, LLC is solely responsible for all aspects of the program. NBCC Approval No. SP-3446

Originally written by Khara Croswaite Brindle, MA, LPC, ACS for www.empowermentmodelsupervision.com/empowering-blog on 05/11/2020

Frequently Asked Questions in Suicide Prevention

Disclaimer: This information is for educational purposes only and is not therapeutic advice nor a substitute for therapy. It should not be used to diagnose or treat any mental health problem. If you are located within the United States and you need emergency assistance please call 911 or go to your nearest emergency room. If you are located within Colorado you may also call the Colorado Crisis Line at 844-493-TALK (8255).

What if suicide happens again within our community?

            That may happen. If and when that happens, our goal is to give resources and support to the survivors. You have the right to be concerned as each suicide impacts, at minimum, 135 people. But, when we provide support to survivors of suicide, we are also opening up healthy conversation about suicide and it’s impact, which may help us prevent further suicides in our community.

In response to suicide, what if I can’t handle it?

            It’s understandable that you would feel that way. Everyone is afraid of suicide and responding to it can feel terrifying. But you don’t have to handle it perfectly for yourself or anyone else.  The point is to be authentic and compassionate and continue these hard conversations. Be aware of what you are comfortable with and prepared for, be gentle with yourself and take it in small steps. We all want to put our capes on and save lives. Recognizing the urge in yourself as well as the fear are the first steps in holding boundaries and compassion together.

How is technology contributing to rising risks of suicide?

            Technology is moving so fast, we can barely keep up! There is new research coming out all the time but the one thing we know so far is that 3 or more hours of social media a day increases risk for suicide. On the other hand, social media and technology apps can make access to support around suicide faster and easier to obtain. The point is not to reject technology or social media all together, but to limit it’s use and focus on meaningful connections and helpful resources. 

What’s happening to our youngest generation that is putting them at greater risk for suicide?

            There is a combination of factors we are tracking in youth, including perfectionism, pressure, lack of social connection, and social media use leading to an unrealistic perspective of success and how they compare themselves to their peers. Fortunately, there are some things we can do that can combat these trends. Most significantly, research tells us that having meaningful connection with even one supportive adult can make a tremendous difference. This is particularly true for youth in the LGBTQ+ population. Our goal is to actively look for ways to help this generation make meaningful connections. It’s not a one and done, it’s complicated. And we need to continue to explore what we can do to support this generation.

What if the person who died by suicide didn’t show any warning signs?

            It’s a common experience for individuals to feel like there were not any signs or they missed them. Often, that’s because, no one person has access to seeing all of the signs that might be there. A student may not share things with their parents. A teacher or a coach may notice things that a best friend didn’t. This is why we have to respond to the threat of suicide as a community and surround our youth with a culture of support. Missing warning signs adds to our fears and yet, suicide is preventable. A person who doesn’t show any signs at all is the exception or outlier. Most people who die by suicide have experienced extreme pain for days, weeks, or months. Our goal is not to look for signs of suicidality, but to look for signs of pain and disconnection and see what we can do to repair the hurt and regain hope. 

Won’t asking a person about suicide give them the idea?

            No. Research shows that asking about suicide when the person is having thoughts of suicide actually brings them relief in being able to talk about it. 

What could I say or do that would make it worse for someone who is experiencing suicidal thoughts?

            Yes but you don’t need to worry. The wrong things to say are easy to avoid. Be sure that you are not minimizing, shaming, blaming, or catastrophizing and instead, you are listening deeply and letting the other person know that you care about their experience. It’s fear that makes us say the thing we shouldn’t. If you start by courageously listening and expressing empathy before you try to move to next steps or solutions, you will naturally find the flow of the conversation that supports the person without making it feel worse for them. 

What do I say to a person when I’m uncomfortable talking about suicide?

            If you aren’t comfortable having the conversation about suicide, find someone who can help! It’s okay to share how you feel and authentically own it. Ironically, it can help the person much more if you are honest. Being truthful and authentic will serve the person suffering much more than having your body language not match your words of reassurance. Simply be sure to let them know that you care about them, and are not judging their experience but rather, are owning that your own experience is making you uncomfortable and talking to someone else would be more supportive for both of you.

As a friend or community member, how can I help someone who is thinking of suicide?

            Knowing that suicide is more about pain than death can help each of us sit with someone we care about to explore that pain, develop compassion, and help them access life-saving resources. There are professional resources, social resources, and internal resources to support someone experiencing suicide. Professional resources would be mental health supports, the national hotline, the text line, and more. Social resources include community support where we can also engage other people to support the person who is suffering. Internal resources would be the person finding things that they live for and help them cope. The best conversation isn’t one conversation, but to have many conversations to compassionately listen and help the person access any or all of these resources as needed.

Why are mental health and suicide rates on the rise?

            There are more stressors and risk factors know now than ever before. Each person has a way of responding to stressors in their lives, with technology, isolation, and other risk factors impacting the rising rates of anxiety, depression, and suicide. Our goal is to combat these stressors by continuing healthy conversations and consciously creating a culture of courageous connections.

Let's save more lives!

Dear Colleagues,

You may be noticing that suicide is showing up more often in your work with clients, whether they are experiencing a crisis themselves or navigating the stress or loss of a coworker, peer, friend, or family member.

Did you know that the American Association of Suicidology reported in 2018 that each death by suicide, at minimum, impacts 135 people? For every suicide death, at least 135 people are affected!

Now if you are like me, this number had a powerful effect on how I think about holding space for suicide in my therapy practice. Holding space for the teen who says no one would care if they were gone. Or the adult who thinks their family would be better off without them. And the young adult who declares that if they haven't figured out how to have a quality life in the next (2.5/5/7) years, they are ending it all. What it's like to hold compassion for their pain, the very pain your client wants to escape from, resulting in suicide becoming a possibility.

For so many of us, our suicide experiences are both personal and professional. As a survivor of suicide loss, I lost two family members to suicide before I was 18 years old. This absolutely shaped my career as a therapist and, like for so many of us, impacted my desire to know more, to understand, to heal.

Fast forward to my first job out of graduate school. One of my first client cases was an 8-year-old who had attempted suicide twice. I was responsible for assessing safety needs going forward and supporting the family with healthy reunification.

For you in your therapeutic work, you are seeing suicide show up, rippling out into the communities you are connected to and serve. And perhaps it shocks you to know that suicide assessment and prevention is not a topic well studied in some graduate programs, resulting in many professionals navigating suicide from a place of fear!

If this feels relatable, you are not alone! Combine this with the rising rates of suicide at a national level and suicide being the leading cause of death for 10-24 year olds in Colorado and we have a perfect storm of paralysis in the face of suicide.And yet the paralysis can be navigated. Navigated well for both the client and you as the professional. 

That's why you are here. You recognize that you are seeking support, insight, resources, and tools to navigate suicide in your work! You are in the right place by considering this course! I am honored to work alongside you in this journey and congratulate you on facing the problem head on! 

Link to the online class: https://savinglivesseries.mykajabi.com/offers/Ga4H4BBR

Let's save more lives!

With gratitude,

Khara

To My Fellow Therapists, Let’s Slather on the Emotional Sunscreen

Spring has been in full swing even as we feel like we’ve taken a pause in this pandemic. Although we may be staying in place, the weather is moving and shifting towards summer. For many of us, weather and the ability to get outside have been vital components to staying sane these last few months. The pleasure of feeling the sun on our faces, the breeze in our hair, inhaling fresh air, and experiencing the sounds of nature can almost transport us into feelings of normalcy.

Normalcy. Normal. A new normal. A phrase that has appeared to help us better articulate how COVID-19 has impacted our way of living and the ripple effects on our habits, behaviors, and mental health. With spring comes new energy, growth, and restlessness. We’ve seen this in the desire for stay-at-home orders to be lifted, the desire to get outside and have social gatherings, and the desire to go back to seeing clients in person. But what about restlessness as a sign of mental health? There are plenty of articles reporting that a mental health crisis will follow as the result of COVID-19 and will be long lasting. Our mental health communities have been working several months straight to support individuals and families with the changes and stresses that have come in waves. As therapists, we’ve prepared for this to some degree, having built practices working with people experiencing anxiety, depression, and trauma. Yet being human ourselves, we are also holding anxiety and dread for what’s to come simultaneously with holding onto hope that it will get better.

Spring Challenges

You see, COVID-19 wasn’t the only challenge to hit us hard in March. Springtime is considered a challenge because it’s known as a time for increased mental health crises. Spring is a time when those who experience the lows of winter and clinical depression related to the darker months start to shift to having more energy. With more energy comes more risks. For individuals experiencing suicidal thoughts, do they now have the energy to make an attempt? For individuals diagnosed with Bipolar disorder, are they experiencing a burst of energy that puts them at greater risk due to increased manic behaviors? Imagine how these worries each spring can combine with the anticipated increase in hopelessness related to COVID-19. For people who have lost jobs, houses, businesses, and loved ones, hopelessness and grief weighs heavy as the weeks accumulate. In fact, as we enter into another month of the pandemic, we may all be grieving the loss of anticipated events or perceived normalcy that summer could bring. The hopes for a planned vacation, a summer break, a slowing of referrals to allow us to regroup. Like a clenched muscle, we feel we must hold on and don’t yet have permission to relax. There continues to be so much that remains unknown about the future months, adding to the rollercoaster of mood as we struggle with not knowing what to plan for or what to look forward to in the ever-shifting weeks to come.

Balance Over Burnout

There is some lightness to balance out the heavy. Mental health professionals are feeling the powerful beauty of connecting with clients on something they too are experiencing in real time. They are embracing raw emotions, vulnerability, and fear. They are expressing gratitude at being able to work via telehealth. They are standing in awe of their clients’ resiliency. 

Therapists are also feeling the burnout of working longer hours and struggling with work separation in working from home. We are human, we are helpers, and we are feeling called to assist others at the risk of caring for ourselves. In connecting with colleagues, it is not uncommon to hear that we feel obligated to help and to remain available. Maybe this would be doable if it was just our clients we were supporting, but for many of us, we are supporting the fear and anxiety of our loved ones, family, and friends as well. It’s a lot to hold, and more than two months in, it’s starting to wear us down.

Slather on the SunscreenWhat can we do to address the growing fatigue as first responders in this pandemic? It’s time to slather on the emotional sunscreen. Embrace this visual of shielding against negativity and practicing professional boundaries. Allow the application of sunscreen to be a gentle and important reminder to protect ourselves from the damage of poor boundaries at the risk of getting burned. Burned by the heavy. Burnt out by the demand. Burnt out by the constant holding of hope and compassion for others. Protecting our emotions. The fight against COVID-19 and its impact on mental health is not over and we are fighting to stay strong.

Reapply Every Two Hours 

So let’s take inspiration from BuzzFeed’s 10 Facts About Sunscreen Most People Don’t Know Due to Marketing Tricks. It is recommended we reapply sunscreen every two hours that we are in the sun. In this case, our metaphorical sun represents all the present stressors, glaringly bright and hard to ignore. They make us uncomfortable, irritable, and tired. So we must take precautions. How do we address the sleepiness and lethargy that too much sun brings? How do we step away, regroup, and restore our energy? How do we protect our empathetic skin from over-exposure to harmful elements that can hurt us, leaving us blistered, raw and achy? We must find a way to reapply our emotional sunscreen to fight off fatigue and feeling drained. Sunburn and burnout have discomfort in common.

More than ‘Make Do’

Discomfort is something we know well as therapists. We are masters at sitting in the discomfort of others to help them heal. We are skilled at compartmentalizing, successfully ignoring our own discomfort to help others. Recall the time you held your bladder so as not to interrupt a session? Or took a call after hours because you could? Or came to work with a head cold so as not to disrupt your client’s momentum? We make do in the face of discomfort, perhaps engaging in the bare minimum protective measures to keep it all moving along. Much like makeup with low SPF. It isn’t enough protection for longer exposure to the sun. Sure, it can serve for short spells or quick outings. But when it comes to sun (stress) exposure of the mental health crisis we are currently facing, minimal SPF isn’t going to cut it. We are in this for the long haul and we don’t want to get burned. We need more emotional sunscreen.

Check Your Expiration Date

More time. More stress. We need to check our own expiration dates when it comes to how much we can handle before we require a break. Last week and this week, I have seen an increase in therapists sharing how tired they are and expressing how they feel like they need a break. This is quickly followed by a disclosure that they cannot leave those they are trying to support during this pandemic out of obligation or guilt. I can relate to this thought process. I can relate to the obligation and responsibility we all feel. We’re helpers. However, I’m also going to champion that all of us take a much-needed break in the near future. Staggered it if need be and timing it to allow rest and restoration. It doesn’t have to be extravagant and it doesn’t have to be long. Sunscreen that has expired is no longer considered effective. If we push past our expiration date, we too are no longer effective. We must honor our own expiration dates and the physical and emotion signs of burnout. Notice the signs that we need to rest and restore in order to do right by ourselves and by our clients.

Maybe it’s a stretch to make a connection between sun, stressors, sunscreen, and burnout. Maybe it isn’t. There’s something reassuring about the idea of getting to a place where we can be mindful enough in our plans to remember to apply sunscreen. Can we apply the emotional sunscreen needed to help us engage in meaningful work without getting burned? Can we show up, remain authentic, and be healthy role models for our clients on taking breaks to avoid burnout? It may not be easy task, but it is doable with practice. They say it takes 30 days to make something a habit. Let’s slather on some emotional sunscreen by summer.

Check out Croswaite Counseling PLLC’s Balance Over Burnout, an online course that introduces 5 tools to prevent burnout for therapists and professional helpers.

Check out BuzzFeed’s full article on 10 Facts About Sunscreen Most People Don’t Know Due to Marketing Tricks here.

An Introduction to The Empowerment Model of Clinical Supervision

What makes a great supervisor? What about a not-so-great one? It has been both surprising and affirming to hear the community’s stories of mental health clinical supervision, including the need for something different, something modern, something more. For many of us, we’ve had a challenging experience where we felt unsupported or unheard by a supervisor. And since research tells us many people leave a job because of their bosses, this becomes even more critical in community mental health where our boss can hold roles as our supervisor, leader, auditor, biller, advocate, and colleague, just to name a few.

Modern Approach to Supervision

So where does one start to improve their supervision experience? There is growing popularity to seek the Approved Clinical Supervisor (ACS) credential when working in the role of supervisor in mental health.  The ACS credential is helping mental health professionals pursue further training and competency in the role of supervision. And yet one of the most referenced handbooks on supervision in support of the ACS training modules was written and released in the early 2000s. Not surprisingly, we need a modern updated approach as the challenges faced in community mental health and beyond require an upgrade. Having worked in community mental health and actively participated in the professional development of a team of 15 green therapists for several years, my awareness of supervision needs was intensified after having a hard supervision experience followed by a heavenly one. My last supervisor in community mental health showed me with her actions what it meant to be empowered and to empower others as a leader and supervisor. Through her insight and my own experiences in the role of supervisor leading to successful, happy supervisees representing the next generation of mental health professionals, The Empowerment Model of Clinical Supervision was defined.  

What is The Empowerment Model?

What does it take to be an empowered supervisor that can empower others? An exploration of redefined roles within the supervisor and supervisee relationship is a place to start. The Empowerment Model names and defines roles of:

·       Self

·       Leader

·       Researcher

·       Teacher

·       Consultant

·       Colleague

You’ll notice that the role of counselor from previous models is intentionally omitted for several reasons, including to respect boundaries and avoid dual roles in the supervisory relationship.

How is it different?

Beyond The Empowerment Model reflecting modern roles within a fluid model rather as opposed to a traditional stair-step model, our initial research findings also indicated that supervisees who were engaged in The Empowerment Model by their supervisors showed significant improvement in categories of General Supervision, The Administrative Counseling Process, The Clinical Counseling Process, and The Conceptualization Process compared to the control group. A model that can be applied for professional growth in both supervisors and supervisees including common ethical and clinical dilemmas in community mental health, why wouldn’t we want to embrace a modern model that supports collaboration and connection?

Where do I learn more?

If we’ve caught your interest in applying The Empowerment Model to your own work as a supervisor, leader, or therapist, you are in luck! 

We offer:

1)    interactive trainings with CEs

2)    a book on Amazon with 33 vignettes for application of the model

3)    a workbook to explore and apply the concepts to your own experiences

all found at our website: https://empowermentmodelsupervision.com

Are you ready to explore what you need in a supervisor? Or ways you can grow into this role in your professional career? We are confident that you will find the materials offered by Supervisionary, LLC approachable, engaging, and empowering to your professional development, and can’t wait to see how it enhances your work within our shared communities of mental health!

Finding Your Passion Projects in a Pandemic

Limit screen time. Exercise. Video chat with family and friends. Go outside. Get restful sleep. America has been bombarded with advice as to how to cope with the current pandemic, and for good reason. This is a time of uncertainty. A time of adjustment. A time for reflection of what is most important. None of us were prepared for the life-changing event that is COVID-19, and as we enter week 5 of stay-at-home orders (here in Colorado), we find ourselves trying to pass the time and hoping for good news at the end of April. Will we get a normal May? June? July? Will we again appreciate live concerts, large gatherings, and colorful festivals that dominate the summer months? Will we plan vacations and travel in the same way as we did before? Will we embrace changes in how our businesses are run? It’s hard to say what the rest of 2020 holds, with many of us taking it one week at a time, both for our sanity and in wanting CDC recommendations to plan our next move.

So how do we stay sane? For some, it’s the escape that Netflix, video games, and reading a good book can offer. Successfully escaping into another world to get our minds off the here and now. For others, it’s framing COVID-19 as an opportunity to reconnect with immediate family, pick up a hobby, or complete projects at home that were pushed off in the past in having no time. I have to admit, my clients have so far reinforced my belief that finding opportunities supports sanity. I feel proud of them in their ability to stay hopeful and attempt to adjust amidst understandable worry, anxiety, and restlessness.

Of course, I need to name the privilege for both myself and my clients in having the luxury of creativity and time for passion projects. Maslow’s Hierarchy of Needs has resurfaced in the public eye and can be used to normalize the contrast between feelings of barely functioning to extreme productivity, and everything in between. Each person can place themselves at a different level of Maslow’s model during this uncertain time. The understanding is that a person’s basic needs of water, food, shelter, and safety MUST come first before anything requiring higher energy can be achieved. As a therapist, I’ve been quick to mention this to colleagues who were expressing their disappointment of moving to telehealth and feeling like momentum would be lost with their clients. I’ve reassured clients that we will take it day to day, week to week to determine how they adjust best and learn to cope. I too, have needed the reminder for days where worry creeps in a little louder than usual, worry that manifests in thoughts like, “What if I run out of projects? When will I have my meltdown? What if I lose focus? What if my mood tanks? What if I can’t hold hope for my clients that this will get better?” One colleague wrote it beautifully on social media. She named that she’s tired. Tired of holding space for others. Tired of the judgement. Tired of the news. I’m tired too. All therapists are tired. We all are getting tired of this. To make it tolerable, we find ourselves grasping for hope, something to look forward to, or something to help us hang on and keep going.

For me, it’s passion projects. You see, I must own my privilege as a white, middle-class citizen who is married with no children. I feel gratitude that my job and my spouse’s job are safe and secure by transitioning to working remote. I also recognize, as a Perfectioneur (Perfectionist Entrepreneur), I have stepped up my game to complete a variety of projects in the last four weeks to feel like I’m making progress, have momentum, and am still creating plans and goals that can make a difference. I understand that my story isn’t the story of all people. I understand that I am lucky to have my basic needs secure and solidified to allow for this higher work to be the focus. If you feel like you are fortunate enough to be in a similar situation, you too might be working hard to find your passion projects during this pandemic.

Why does passion matter? For Perfectioneurs and other entrepreneurs, we are happiest when we are creating, innovating, and supporting meaningful change. So it’s no wonder that we would do our best to embrace the opportunities the pandemic provides to work on things that have always felt important but have been pushed further down the to-do list due to busy-ness. As the result of COVID-19, we have been forced to slow down. To re-evaluate. To plan. In my first four weeks of the stay-at-home orders, I’ve written half a dozen blogs, finished a draft of a new book, created supplemental material for an online subscription service, and filmed and launched two new online courses. 

I’m not asking for a pat on the back because I’m not unique. In fact, some of our most celebrated creatives produced their best works while under quarantine. Check out these articles that named William Shakespeareand Isaac Newton, as two examples. Perhaps it speaks to the value of space and time to allow ideas to come forward. The ideas generated when we have time on our hands, can’t sleep, or when we are forced to sit with our own thoughts in the early hours of the morning when limited distractions are available. As you can imagine, this could easily shift into mental health challenges or crises when thoughts unravel our sense of purpose, identity, or make us question it all. 

But for others, these thoughts can lead to strokes of genius or passion projects. Holding onto hope that the challenges we face in the present will lead to something beautiful in the future! How do we embrace that gift of creativity? The ah-ha moments leading to meaningful change? 

1.     Take a walk

Walking supports bilateral (left-right-left-right) movement in the body that can support creative thoughts and ideas. It’s a reason why people find themselves pacing when trying to find an answer. Movement can be a powerful strategy in generating solutions to the problems we face.

2.     Write it down

Keep a journal or notebook handy. Or use your notes feature in your phone. Some of our best ideas come to us right before sleep, in a dream, or while we are chatting with a colleague or friend. Writing it down captures the idea for later while giving you permission to be present in the moment.

3.     Run it by a colleague or friend

There’s something powerful about sharing an idea with a trusted colleague or friend to see what questions come up. Do they see the same value you do? Do they have additional perspective that would help your passion project form? 

4.     Workshop it 

If your passion project holds the potential to help others, workshop it to take a deeper dive into its value. Who is the intended audience? Who are your competitors? What pain point are you addressing and why? What makes it stand out? How does your passion project offer a solution?

Passion projects, like hobbies, can support moments of joy and feelings of progress and momentum. In a world that feels stuck as the result of COVID-19, projects can be a welcomed escape from the stress of the unknown. Not everyone will have the ability to embrace passion and creativity in dealing with immense pain, grief and loss as the result of the pandemic. Passion projects could offer some respite from the heaviness and hopelessness felt throughout our communities. After all, we are allowed to feel both gratitude and grief at the same time. So I hope you will consider unlocking your creative potential during this strange moment in time. Embrace your own resiliency. Our passions can bring out the best in us while we adapt in the face of adversity, helping map out positivity and sense of progress in the current pandemic.

Medicaid Mastery in your Practice

Disclaimer: Medicaid in each State and Region have different expectations. I am not employed by Medicaid, therefore any information conveyed here is subject to change and should be further explored by you and your Medicaid Liaison. This blog is not meant to train or advise you on how to bill Medicaid for your services but as a base from which to understand an overview of generally accepted practices from a Medicaid standpoint in the State of Colorado with regards to paperwork compliance.

You hear the word AUDIT and maybe the first image you think of is an agent in the movie The Matrix. The uniform dress code, authoritative air, serious tone, and unreadable face? Perhaps you envision an auditor setting up camp in your office for three days straight, going through your files with a fine-tooth comb?

Reducing Audit Anxiety

Medicaid can be scary and it can also be rewarding in being able to work with the clients you love serve. Luckily, for many private practice therapists in Colorado who are Medicaid Providers, an audit doesn’t look quite as intense as a Matrix movie scene.  In my experience so far, an audit request from Medicaid (at least in Colorado) comes in the mail and tends to be packaged as a request for several progress notes or documents on various clients, to then mail or fax back to Medicaid within 30 days for review. At that point, you would get a percentage grade of compliance and written suggestions for improvement going forward as a Medicaid provider. From this basic explanation, some of you are breathing a sigh of relief knowing that you have your paperwork ready and able to send off in a timely manner.

Solutions in The Super Six

But what about those of you who aren’t feeling so confident? To be honest, we know that the majority of therapists did not get into this profession for paperwork. You were called to this work to help others and to make a difference. In an effort to streamline your process and continue meaningful work with your clients, please allow me to introduce you to The Super Six paperwork items Medicaid (in Colorado) requires for compliance.

1)    CCAR: Colorado Client Assessment Record

The CCAR is an administrative document that provides a snapshot of client functioning at intake, update, and discharge. It’s currently on hold indefinitely by State Medicaid who is reporting updates to their system as of July 1, 2018. So far any of you starting with Medicaid in Colorado, you are in the clear! And for those of you working with clients prior to July 2018, you’ll want to have a CCAR (or several) included in your client file.

2)    Mental Health Assessment

Just as it sounds, the Mental Health Assessment is part of your formal intake to explore symptoms, client needs, and justification for a mental health diagnosis. It also serves as a temporary treatment plan as you continue to build rapport and in further sessions to refine and confirm your goals with your client. Mental Health Assessments cover a significant span of questions including mental health history, family history, legal involvement, substance use, trauma, developmental milestones, and more.

3)    Treatment Plan(s)

A treatment plan is an outline of goals and means to make progress in therapy. Many therapists have adopted the SMART acronym as a framework for formatting a therapeutic treatment plan, which stands for Smart, Measurable, Attainable, Realistic, and Timely. Treatment plans should address the diagnoses given to a client at intake and reflect means of making progress towards those goals. Treatment plans should be updated regularly, recommended as every six months. Lastly, treatment plans should be personalized to each client including capturing in their own words what they would like to accomplish in therapy with you.

4)    Progress Notes

The meat of the therapeutic file, progress notes provide the trail of progress made in the therapeutic relationship. An auditor expects to see what you contributed in each session as the provider, the client’s response to the therapeutic interventions offered, the progress made in each session, and the intention of future sessions. SOAP or DAP notes are an acceptable format with some minor tweaks for Medicaid compliance.

5)    Discharge Summary

When a client in no longer working with you in therapy, planned or unplanned, Medicaid desires a summary of the client at discharge. This document tends to be placed at the top of a file as a snapshot of closure from services including frequency of sessions, medication(s) at time of discharge, recommendations, and designation of discharge as positive, negative, or neutral. Designation can be interpreted by you as the therapist, with some examples being a positive discharge if finished with their identified goals, negative discharge if the client disengaged or ghosted therapy, or neutral for when a client changes insurance funding or moves out of state, preventing them from continuing in therapy with you as their provider.

6)    Medicaid Client Rights

The last of The Super Six is a document provided by Medicaid as providers are contracted and approved to see Medicaid members as clients. Similar to your own mandatory disclosure statement, the Medicaid Client Rights is a document that outlines your client’s rights in using Medicaid for medical and mental health services, including items such as each member has the right to the best fit therapist, right to access their file, right to file a grievance, and more.

The Evolution of EHR

So you’ve got the paperwork down, knowing that Medicaid still loves paper files and client signatures throughout. But what if you are wanting to go paperless with an EHR (Electronic Health Record)? The good news is that EHRs have really simplified paperwork compliance, allowing the writing of notes, signing of documents, and billing of claims, all with the click of a button! With that being said, you will still need to modify templates in any EHR you use, knowing that they aren’t automatically Medicaid compliant. 

Some suggested modifications and tips for EHR and compliance include:

a.     Identifying the place of service on your session progress note (i.e. office, community, group home, client home)

b.     Ensuring your full legal name and credentials are reflected in the note as you lock it to electronically sign it 

c.     Writing and signing/locking your notes within seven (7) business days of the completed session

d.     Indicating the next scheduled session with full date and time to show intention of continued therapeutic work

e.     Including the Medicaid number/identifier for your client in each note

Final Tips for Avoiding an Audit

The paperwork may feel cumbersome, but if you can master it, you can master any other private insurance’s requirements for compliance as many find Medicaid to be the most rigorous! Allow yourself to adopt new strategies to refine your paperwork process and feel confident that you can pass an audit! Keeping confidence in mind, here are some final tips to help you master Medicaid!

1.     Never collect money from a Medicaid client or their family

2.     Obtain client signatures on your Mental Health Assessment and every treatment plan

3.     Be cautious of billing case management if working within a traditional outpatient therapist role, this is one element that increases risk for audit due to others’ misuse.

4.     Be sure to explore compliance needs within your state and region and move forward implementing changes as soon as you become aware of them

You’ve done it! You’ve utilized this blog as an initial framework and checklist for Medicaid Mastery and Audit Avoidance! Congratulations on your hard work and welcome to the Medicaid family!

To Conquer or Die: Pivoting as a Recovering Perfectioneur

Control Freak.

Entrepreneur.

Workaholic.

Type A Personality.

Perfectioneur.

A Perfectionist Entrepreneur

Have you ever worked so hard at something that you made yourself sick? Maybe it was that time at the gym where you pushed yourself so hard in a workout that you felt physically ill. Or during dead week in college, that week before finals, where you worked so hard to feel prepared, only to get sick after finals were over. Working so hard to master something, it’s something I know a lot about as a Recovering Perfectioneur. 

There are many Perfectioneurs in this world, managing the workforce with the badge of busy-ness. 

How’s life? It’s busy! 

How are you? So busy! 

Responding to an American culture of independence and prosperity, we are a breed of Entrepreneurs driven by desires to create, to make an impact, and to lead change. A group of hustlers that epically fail at self-care and work-life balance. Running themselves into the ground out of a desire to accomplish things that feel important, meaningful, and worthwhile. A group of Millennial and Gen-Z ers who were taught to work hard for what they want, only to find themselves overworked, burnt out, and with higher risks of anxiety and depression.

A phrase that captures this experience: To conquer or die. It’s a family motto I believe to my core, even going so far as to tattoo it on my body! And as a result, I was nearing collapse and total breakdown. That’s when I learned I needed to recover as a Perfectioneur.

That’s me, now what? 

So maybe you resonate with this definition of Perfectioneurs. If this is you, there is hope! Let’s look at some ideas outside of the commercialized concepts of self-care that can help you heal and grow for the better.

1.     Rest versus Restoration

Self-care from an American standpoint might present like a vacation, massage, or other costly thing that is meant to encourage a person to slow down and take a breather. For many of us, the luxury of spending money on such items can be a struggle. Perhaps it’s not even the financial stress but the struggle to carve out a chunk of time in your full schedule to complete it. Feeling like we don’t have time is half the battle. With this in mind, it’s no wonder planners have come back into popularity, with the purpose of blocking out time for yourself, your friends, and your family.

So now it’s the weekend and you decide to binge watch Netflix and lounge on the couch to rest after a very full week. Do you find yourself feeling rested? What about restored? Rest is the idea of limited or low activity. There is purpose to rest. But for so many of us, rest doesn’t provide us with renewed stamina or energy to keep achieving and progressing. We are still tired. We are still overwhelmed.

Instead, perhaps we embrace the concept of restoration. What are some things that energize you, restore your energy, revitalize you, bring you back to yourself? Interestingly enough, the list of ideas for self-care shift when presented from the lens of restoration! Maybe now you are thinking about being in nature, cooking a delicious meal, or dancing to good music. Rest and restoration have value for Perfectioneurs and Entrepreneurs, it’s important to identify a balance of both.

2.     Who’s in your orbit?

As you think deeper about restoration, perhaps there are cherished people in your life that you want to be involved in that experience. Do you feel restored when surrounding yourself with loved ones? Fellow Entrepreneurs? Creative thinkers? Dreamers? Giving yourself permission to explore the relationships that energize you can be insightful into how you spend your time. Recognizing individuals who drain you, ask too much of you, or relationships that just don’t feel reciprocal, can be adding to your risk of burnout when feeling overworked and overscheduled. Give yourself permission to focus on the relationships that boost your energy and creative spirit, they will be the ones you’ll want to schedule and make time for because of how they make you feel.

3.     Find your Focus

Balancing your time, your relationships, and your goals can be difficult. And yet, now that you’ve identified the relationships and activities that energize you, you can bring those goals into focus. What if I asked you to write down some goals that are showing up in your mind in this very moment? What items are on your agenda? 

What if I told you that you can only focus on 7 goals in the next 6 months? For those of you who are hustling hard, this may feel restrictive, challenging, and create anxiety and resentment. What would you cross off your list, giving yourself permission to focus on only these 7 goals for the next 6 months? It may feel difficult at first, but it’s amazing to find yourself making more significant progress on the 7 goals because you are also saying NO to everything else. We know that multitasking can be done, but at the risk of lower productivity and limited outcomes since your energy is spread too thin. I encourage you to embrace this exercise of identifying 7 top priorities in your goals list and leave the rest to be added when these 7 are accomplished. You might surprise yourself in how you feel, recognizing more energy, focus, and progress as the result of your efforts!

These are just three strategies that I’ve worked on in order to come back to balance, health, and healing.  And like anyone else in recovery, it’s a choice every day to do something that’s in your best interest. If you decide to take the leap, recognizing yourself as a workaholic, a Type A person, an Enneagram Type 3, or as a fellow Perfectioneur, I can’t wait to see how these strategies work for you, not only to move closer to your values and feelings of fulfillment but to change the narrative of Entrepreneurs for the next generation trying to make a difference for all.

If you’ve run yourself into the ground, the only direction to go is up!

Attract and Retain Millennials: a quiz to learn how to make a greater impact with your Millennial employees.

1.When assigning a task to a Millennial employee, what is your best approach?

a. Explain why the project is important and why their role is valuable

b. Convince them by repeating yourself until they agree

c. Send an email of the project and deadline

d. Tell them they need to do it promptly or else consequences will follow 

2.What is the best way to have your Millennial employee feel valued at work?

a. Give them more work to do

b. Advocate for them on their behalf during a tough meeting

c. Remind them that they are just a cog in the wheel 

d. Take them to coffee outside of the office 

3.What is the best way to empower your Millennial employee in the workplace?

a. Give them flexible hours and the option to work from home periodically 

b. Provide free food

c. Allow them to wear jeans more regularly 

d. Tell them to just keep working hard and good things will come 

4.What is the best way to instill loyalty in your Millennial employee?

a. Have them sign a non-compete agreement so they don’t leave

b. Tell them that this is the best company for them

c. Promote them to a new role without a pay increase or title change

d. Create a compensation package that supports work life balance

5.What is the best way to provide constructive feedback to your Millennial employee?

a. Give them tough love

b. Use the sandwich technique

c. Don’t provide feedback at all because Millennials are sensitive 

d. Provide verbal affirmations in constructive and compassionate ways

6.What is the best way to keep your Millennial employee happy and satisfied in their position? 

a. Ask them often if they are happy

b. Buy donuts weekly 

c. Consider creating more rungs in the ladder of career advancement

d. Have them take a quiz on happiness in the workplace 

Add up your points for each response: 1. a-4 b-1 c-3 d-2 2. a-2 b-4 c-1 d-3 3. a-4 b-2 c-1 d-3

4. a-1 b-2 c-3 d-4 5. a-2 b-3 c-1 d-4 6. a-3 b-1 c-4 d-2.  Total Points:______

Score 24-19: Cool, I’m a Millennial Expert!

Score 18-12: Middle of the road Millennial management

Score 11-6: Nope, Millennials are Aliens!