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CPT Code 96127: Improving Patient Care and Your Bottom Line

In January 2015, CMS implemented CPT code 96127. The code was part of the ACA’s mandate that mental health treatment be part of the essential benefits provided by insurers.

Many clinicians are excited about the ability to use technology to measure their patients’ progress and enhance engagement. One thing that may be holding them back is the cost of implementing these solutions. The good news is that because these services improve patient care and outcomes it is possible to bill for them using CPT code 96127.

Not sure how to use this code? Want to start using technology in your practice and aren’t sure how to bill for it? Read on for some tips.

What is CPT Code 96127?

CPT code 96127 is for the administration, scoring, and documentation of a brief behavioral/emotional screening.

What types of assessments would qualify for 96127?

Examples of these screeners are the PHQ-9, GAD-7, AUDIT, and DASS-21. Essentially, these are brief measures used to assess for depression, anxiety, suicide risk, substance abuse, ADHD, eating disorders, etc.

How do I use code 96127?

The code is per screen administered. You can bill for up to 4 screeners per patient, per visit, and can be reimbursed up to $6 per screen, so up to $24 per visit.

Do I need to administer the assessment?

No, the assessment can be given/scored by trained administrative staff.

Is it really worth it?

We think so. If you used 2 assessments with 10 clients on a weekly basis, and were reimbursed $6 per assessment, you would easily cover the cost of the software used to administer the assessments. Assuming four visits/month, that would be $480 per month of additional revenue.

Aside from financial reasons, the use of these measures can help improve client engagement, and studies have shown that practitioners aren’t always able to detect client decompensation. Furthermore, measurement-based care has been shown to improve outcomes. Now that it’s possible to get reimbursed for the administration and scoring of these measures, why not do it?

What insurance companies will reimburse for this code?

Many major insurance companies reimburse for 96127 including Aetna, Cigna, Medicare, United Healthcare, and others.

What’s the best and easiest way to administer these measures?

Pacifica offers a library of publicly-available standardized measures in its Clinician Dashboard.

Note:

It’s important to remember that reimbursement rates will vary, and providers should check with carriers to determine what the reimbursement rate is for the companies they are billing. This blog post does not constitute legal advice.

 

Taking A Mental Health Day: The Importance of Self Care

Madalyn Parker is a software engineer for a company called Olark. She’s struggled with depression and anxiety and has been open about her experiences. Recently, she took a mental health day and tweeted her CEO’s response to her Out Of Office email, since it was so supportive.

 

The tweet went viral and has sparked a conversation about mental health in the workplace, company policies, whether you should just take vacation time, whether mental health is the same as physical health, etc. Unfortunately, many of the comments have been individuals sharing how they’ve not experienced the same level of support in their jobs or from their supervisors.

Mental health has long lagged behind physical health in terms of public understanding, medical coverage, and even treatment quality. As the economy is shifting to a more “knowledge-based” one, employers are increasingly realizing that it’s critical for employees to be mentally well in order to perform at their best. This means providing benefits such as counseling or employee assistance programs, access to gyms or yoga classes for stress relief, or simply being understanding when someone needs a few days off for self care. In addition to helping keep employees performing at their best, a positive work environment like this can help attract and retain top-quality employees.

Last year, a series of articles in Huffington Post covered different aspects of mental health in the workplace, and highlighted the fact that employers respond to employees’ disclosures of mental health struggles in a variety of ways. Some positive outcomes include the employer offering paid time off, temporarily or permanently adjusting the employee’s responsibilities, or simply opening lines of communication about the workplace environment. Unfortunately, there are also many possible negative outcomes, such as the supervisor tacitly supporting the employee while gradually preparing to terminate them. One person reported that their boss spread rumors about them. Increasing attention on the importance of mental well-being and awareness of the economic costs of absenteeism and lost productivity has shed further light on this issue and the need for employers to be supportive. Even if an employer can make an argument that they have an organization to run and/or can’t employ unproductive individuals, the fact is that we as a society will have a long-term benefit from companies being more inclusive and looking at individuals holistically, encouraging self care, and supporting healthy work-life balance, including employees’ mental health.

In addition to government regulation to mandate parity for mental health treatment or time off, employees will also benefit from prioritizing their own self care. Keeping close tabs on one’s health behaviors such as sleep, alcohol or caffeine intake, or stress levels can help. Individuals often forget that sometimes taking a little time off to, for example, attend a yoga class or therapist appointment, while it might cut into work time in the short-run, could ultimately mean better performance and presence at work in the long-run. Reducing burn-out and increasing employee motivation to perform can have immeasurable benefits to a company in the long run.

For more tips on how to manage work-related stress, check out a previous blog post here.

HIPAA Compliance for Mental Health Clinicians

Note: This blog post is not a substitute for legal advice. It’s just a blog post.

You’ve decided that you want to start using technology in your practice, whether it’s using an EHR, offering teletherapy, or even emailing with clients. Great! Your clients will thank you for it! But first, you need to be familiar with HIPAA, the Federal Law which establishes national standards for electronic health care transactions and identifiers for providers, health insurance plans, and employers.

FREQUENTLY ASKED QUESTIONS ABOUT HIPAA ANSWERED IN PLAIN ENGLISH

What is a Business Associate Agreement (BAA)?

The BAA is an assurance from a service provider (business associate) that they will safeguard your clients’ data in the same ways you as a clinician (covered entity) are required to. It also clarifies and limits how service providers use and disclose protected health information (PHI). Finally, it highlights the appropriate safeguards necessary to prevent unauthorized use or disclosure of PHI. If a company will not sign a BAA with your organization or practice, then you should not trust them with your clients’ PHI.

Why do I need a BAA?

Because HIPAA says so. Every covered entity must have a written agreement with each of its business associates, or else it is not compliant with HIPAA regulations. Your “business associates” are all the various service providers who interact (“create, receive, maintain, or transmit”) with your clients’ data: email, video, records, texts, etc.

Yeah but what will really happen if I’m not compliant? I’m just a small practice.

It’s not worth the risk, and your organization’s size doesn’t matter. The federal government has the latitude to impose both civil monetary fines and criminal punishments upon individuals and organizations that violate HIPAA. Under the current omnibus HIPAA rules, each violation can incur a penalty of up to $50,000, with repeat violations of the same provision costing as much as $1.5 million per year. In the first seven months of 2016 alone, HHS recorded close to $15 million in HIPAA violation settlement payments.

I don’t have a BAA with Google and use Gmail. Is it enough to simply ask my clients to not email me sensitive information?

Probably not. Even a simple emailed appointment reminder can be considered ePHI. In order to be in compliance, you’ll want to use a provider with whom you can sign a BAA, such as by using G Suite (Google). It’s important to note that in the case of G Suite, your data will be encrypted on Google’s servers, but may not be fully encrypted while in transit. Given that, it’s advisable to document that your clients have provided informed consent to communicate via email.

There are services that are designed to provide fully-encrypted email solutions to providers. Some examples are Hushmail, or Protonmail. Remember you NEED A BAA between yourself and the company to be compliant! Simply signing up for a service from a provider who claims to be HIPAA compliant is not enough.

Can’t I just use FaceTime or Skype for teletherapy? My client says they’re OK with it.

No. Your service provider must sign a BAA with you to be compliant. To the best of my knowledge, Apple currently does not sign BAAs with FaceTime users. Microsoft (who owns Skype) will enter BAAs, but not for Skype. What about Google Hangouts? No. Google will sign BAAs for email (see above re: G Suite), but not for Hangouts. It’s not enough for your client to be OK with using one of these services, and therapists would be well-advised to remember that just because a client says they’re not worried about the privacy of their data today doesn’t mean they won’t sue you in the future.

Can I use something like SurveyMonkey or Google Forms to administer assessments?

Yes, if you sign a BAA with either SurveyMonkey or G Suite (Google) to do this. 

So do I have to sign a whole bunch of BAAs to be HIPAA compliant?!?

Yes, if you are using multiple different types of services. Alternatively you could opt for the simplicity of having a provider that offers a number of services in one platform. Pacifica offers HIPAA-compliant teletherapy, assessments, and access to a large library of CBT- and mindfulness- based therapeutic content. Learn more here.

7 Tips for Incorporating Technology Tools into Conventional Therapy Practice

Individuals seeking health care are increasingly interested in using technology to help manage their symptoms and obtain treatment. A poll by The Pew Research Center reported that in 2012, 72 percent of Internet users reported seeking health information online (PRC, 2013) and of the 64 percent of people who own a smartphone (PRC, 2015), 62 percent reported having used it to acquire some type of health-related information (PRC, 2015).  These trends in general health present a great opportunity for improvements to existing care-delivery models in mental health too.

Mobile apps are a burgeoning area of health technology which have substantial opportunity to improve treatment, quality of life, and patient self-management and engagement. Numerous professional and non-professional groups have acknowledged the value of these tools, as they are often well-liked by users and have advantages over traditional in-person therapy. For many individuals, therapy is out of reach due to cost, access/provider availability, transportation, or stigma. Though not necessarily a replacement for traditional therapy, apps and other healthcare technologies can help these individuals overcome these barriers and begin to reduce their symptoms and better manage their mental health.

For others, apps can be a helpful adjunctive to regular treatment, allowing them to be more engaged and get more support between sessions. While in-person therapy offers a human relationship that isn’t always possible within an app, mental health clinicians have an opportunity to work WITH these tech tools to enhance their in-person work and take advantage of the benefits that come with the use of technology in their practices.

When beginning to introduce apps into your practice, there are some things to consider in order to be successful and ensure your clients accept and use the new technology.

1. Think about your goals–what will the app help you or your client to do? Don’t introduce technology just because you can. Have an idea of what you think the app or program can be good for, and explain that. Perhaps it’s mood tracking or building a mindfulness meditation practice. Make sure that whatever tool you are suggesting is clinically appropriate and indicated for that client.

2. Be familiar with the tools you’re suggesting. A surefire way to make your client doubtful of the technology is to lack understanding and knowledge of the app and how it works. The more comfortable you are with the app, the more they will be too. Download and use the app yourself. In addition to having more credibility with your clients, you may discover interesting or valuable ways to use the technology that perhaps aren’t immediately obvious otherwise.

3. Put yourself in your client’s shoes. When introducing the client to the app, don’t grab the client’s phone and do it for them. Instead, talk them through the process, allowing them to click through the different tools and describing what to use and when so that they feel a level of familiarity with the app before they leave your office. This is particularly important for apps that have minimal in-app guidance.

4. Problem solve using the app. When might a client want to use a given tool? Provide some suggestions for scenarios and think about any difficulties they might run into ahead of time.

5. Don’t overwhelm yourself or your clients. You might find it helpful to pick just one app at a time to keep it simple. If you start using a wide variety of products, it may be difficult to keep track of how the apps work, what they do, etc.

6. Be familiar with the app’s security and privacy policy. Your clients may have questions about their app usage data and what happens to it. It’s helpful if you have at least some knowledge of the app’s policies so that you can either explain those policies, or know where to direct your clients so that they can read the policies themselves.

7. Have a discussion about the use of the technology much like you would have at the beginning of therapy. What are the limits of confidentiality? Will your client expect that you will be reviewing their app usage? Should they use the app to communicate with you? It’s important for provider and client to have an open and frank conversation about what is and is not appropriate for app usage, and what the client’s expectations should be. Some clients may not fully understand how apps work, and it’s incumbent upon the provider to make sure their clients are informed before beginning to use an app or other tech tools.

Thinking about taking the leap of bringing your practice into the 21st century by starting to work with a mental health app? Consider Pacifica. Pacifica is a mobile application that empowers people to manage their stress, anxiety, and depression using cognitive behavioral therapy (CBT) and mindfulness techniques. The app currently has over 1.4 million registered users and has been highly-rated and well-received in the App Store and Google Play Store, reflecting its appealing design and engaging tools.

In addition to its iOS and Android consumer apps, Pacifica Labs also offers Pacifica for Clinicians, a dashboard tool designed to help mental health care providers leverage the app with their patients and improve treatment effectiveness. The HIPAA-compliant clinician-facing product allows providers to administer and score assessments, conduct teletherapy, and increase between-session engagement and therapeutic efficiency with assignments and education.

 

Pacifica Mindfulness Updates

We’re delighted to announce the recent renovation of Pacifica’s relaxation and meditation section. Some of the changes we’ve made to this section of the app:

New Design
Perhaps the most obvious change, we’ve shifted from a list to a more visually appealing format, with images that provide some information about the nature of the activity. We’ve also simplified the display of the meditation lengths and updated some meditation names.

 

Daily FREE Meditation
Each day, a different Premium meditation/relaxation activity will be featured and will be available for free. 

New Meditations
These new activities will help you to build new coping skills and think differently.

  • Building PositivityUse mindfulness to identify wins, focus on the upside, and savor moments of joy.
  • Getting Motivated: Use this meditation to build initiative and move towards your goals.
  • Eating Mindfully: Be fully present while eating to savor the experience.
  • Coping with Physical Pain: Use mindfulness to help you manage pain.
  • Defusing Anger: Use mindfulness strategies to cope with frustration.
  • Falling Asleep: Release your stress from the day while relaxing into sleep.

Updates to Existing Meditations
We’ve improved and updated our existing meditations, particularly those designed to help you coping with anxiety-provoking situations, like taking a flight or being in social groups. Be sure to give these a listen!

Meditation Reminders
You can now set up daily reminder notifications for meditations, to help you build a mindfulness habit.

Do you have suggestions or requests for meditations you’d like to see in the future? Send us an email at info@thinkpacifica.com with your ideas!

Our ethical obligation to practice outcome monitoring

Why did you become a therapist?

Many people say that they went into therapy in order to help people, yet despite this initial goal, they report that they actually spend most of their “office time” writing notes and completing paperwork. With complicated EHRs, large caseloads, and increasing administrative responsibilities, some of this is inevitable. Fortunately, however, new tools and technologies are emerging to help clinicians to not only fulfill their job duties, but also more effectively treat their patients and ensure that they are providing quality care and utilizing best practices.

One of the best practices that has been demonstrated repeatedly to improve outcomes is using Measurement-Based Care. Measurement-Based Care is a system that utilizes patient-reported symptom rating scales to inform clinical decisions about patient care. Similar to Measurement-Based Care, outcomes monitoring or progress monitoring, is the routine collection of self-report data from clients to evaluate their progress in treatment and perception of the therapeutic alliance. In both Measurement-Based Care and outcomes monitoring, clinicians use the self-report data provided by their clients to objectively assess their progress and make adjustments to their treatment plan or therapeutic approach in accord. Therapists have been slow to adopt routine progress monitoring or Measurement-Based Care, but the time has come to change that. In addition to standard measures of symptoms (e.g. PHQ-9, GAD-7), there are several published measures which can effectively provide feedback to the clinician (e.g. OQ, ROM, PCOMS). With a wide variety of validated measures available to assess one’s clients, there is little reason not to develop a thoughtful plan for evaluating one’s practice.

Improved Communication

Providers’ desire to offer the highest quality of care possible is not the only reason to practice outcomes monitoring or Measurement-Based Care. Monitoring can help patients to stay more engaged in their treatment and more participatory, both in sessions and with between-session assignments. They are less likely to stop treatment if they feel heard by their clinician. Structured measures provide another opportunity for the therapist to listen to the client and get a better understanding of their emotions, experiences, and feelings about therapy itself. Therapists often report having a strong desire to meet their clients where their clients are ready to be met. Providing an additional channel for communication (i.e. other than informal queries in session) will help them move towards this goal. Some clients may feel more comfortable disclosing a symptom or therapeutic rupture on a form than directly to the clinician; the use of objective, validated measures can allow therapists to be aware of these issues without requiring the client to bring them up on their own.

Clients are also less likely to drop out of treatment if they feel that their therapist is responsive to their needs. This means being aware of both the client’s symptoms and the degree to which they are suffering, and being cognizant of the therapeutic relationship and ensuring that it is productive. Studies have repeatedly demonstrated that there is often a disconnect between how the client feels and how the provider thinks the client feels, and therapists who are able to minimize this gap and flexibly respond will find that their clients stay in therapy longer and get well more quickly.

The Time is Now

Advances in technology have led to the development of a number of different methods for administering, scoring, and integrating clients’ responses to both symptoms and outcomes measures into the EHR, to minimize the burden on providers and administrative staff. Clients are increasingly interested in using technology tools to manage their health care, and the use of such devices and programs to monitor treatment progress is an excellent application of such technology.

Many clinicians have been proactive and excited about implementing empirically-supported treatments, and have been outspoken advocates for the use of proven therapies. Why are we so resistant to outcome monitoring and Measurement-Based Care? While behavior change is never easy, as healthcare providers we are obligated to do it when we know there are effective, proven strategies we can implement to improve our care delivery. This means doing progress monitoring and adjusting treatment plans and interventions based on our clients’ feedback. Mental health providers are also health care consumers, and I challenge them to imagine seeing a physician who does not routinely make objective measurements such as blood tests and weights while crafting and managing a treatment plan. Why should mental health be any different when it comes to tracking progress?

Originally published on PsychCentral Pro: https://pro.psychcentral.com/our-ethical-obligation-to-practice-outcome-monitoring/0019316.html

Managing Work-Related Stress

Many of us experience stress related to our work environment. After all, full-time employees spend about half of their waking hours at work. Often our co-workers become the people we have the most daily contact with. Unfortunately, intense pressure to succeed or complicated interpersonal situations can build tension and lead individuals to feel overwhelmed or burned out and dread going to work in the morning. The good news is that there are some things you can do to manage work stress and improve how you feel about your job.

Take good care of your body. Getting enough sleep, not overdoing it on the office coffee or break-room sweets, and getting regular exercise can help. If you have trouble falling asleep at night, try eliminating afternoon caffeine and turning off screens an hour before you want to fall asleep. Develop a regular pre-bedtime routine like a warm bath, cup of herbal tea, or reading a favorite book. You could also try practicing a meditation or relaxation exercise in the evening to help wind down. Physical exercise can be great for boosting your emotional state–it causes the release of mood-boosting hormones and can help you let go of the stress of the day.

Develop boundaries. Due to the development and ever-increasing presence of communication (phone calls, emails, instant messages, webinars, texts, social media, etc), it can be hard to find time to focus on doing your actual work. Blocking out time in your calendar when you are unavailable can be helpful. Alternatively, you can make specific times available for meetings and last-minute tasks so that they don’t crowd out other things.

It’s also important to have good work/life balance, which might mean turning off your phone in the evening or turning off email or message notifications. It can be hard to put your own needs first, but when you feel rested and like you have your own personal space, you will be much more productive when you ARE in the office.

Delegate, prioritize, and communicate. Remember that you are not the only person at your company. Ask co-workers to contribute with tasks that aren’t in your area, or if you feel you won’t be able to get them accomplished in time. It’s important to keep your job title and role in mind. Prioritizing what needs to be done first and breaking those tasks down into smaller steps can help you feel less overwhelmed and have a clear path forward.  In cases where you need to have difficult conversations with others, try to be specific and clear about your concerns or complaints, and focus on their actions or behaviors rather than their character. Try to avoid gossip and talking about that individual with people other than the individual themselves.

Practice self-care. This could be as simple as taking a ten minute break during your day to practice a guided meditation. Meditation and deep breathing exercises can help you reduce your work stress by redirecting your attention from negative thoughts or emotions.  On your time off, take time to do something fun, like re-engaging with a hobby, or connecting with friends or family. Use your vacation time, stay home when you don’t feel well, and remember that you need to take care of yourself to be your best.

Consider all angles. Difficult or complicated interpersonal situations are not uncommon in work environments. It’s important to keep in mind that our perceptions of these events are just that–our perceptions. Everyone interprets things differently, and it can be helpful to take a step back and try to objectively identify what’s happened. Perhaps you’re making assumptions about someone else’s motives, or allowing your frustration from some other area of your life to bleed into what’s going on at work. Using a thought record (such as the “reframe” tool in the Pacifica app) can help you to break the situation down and get a clearer view. Once you’ve done that and taken a moment to reflect, you can then respond more appropriately.

Bringing Mental Health Services to Underserved Populations with Teletherapy

To better reach underserved populations, mental health care providers need to increase accessibility, decrease costs, and eliminate barriers to entry for groups facing difficulties in obtaining mental health services. According to the National Alliance on Mental Illness, one in five American adults experience a mental illness. Unfortunately, these numbers can be even higher for certain groups that also tend to struggle more with getting the help they need for economic, cultural, social, or logistical reasons. These factors, combined with a mental health care provider shortage, can make it prohibitively difficult for some individuals to seek help.

One way providers can effectively reach more underserved populations without incurring a high level of extra costs is by offering teletherapy. Studies have shown video therapy sessions to be just as effective as traditional, in-person therapy for treating most mental health conditions. Providing teletherapy can be significantly less expensive for providers by removing overhead costs, and can also improve attendance rates and reduce no-shows and cancellations. It is also more anonymous for clients and removes geographic restrictions, which can make it easier on clients with limited transportation, and gives clients more options when choosing a provider.

In addition to being convenient and effective, teletherapy can also be reimbursable, making it easier for clients to afford mental health services. Medicare’s telehealth benefit now covers certain forms of psychotherapy services. Telehealth is also covered by Medicaid in 48 states and the District of Columbia. Furthermore, 32 states and DC have some sort of private payer policy in place for coverage of telehealth as well.

Teletherapy can solve logistical issues and remove barriers for many different groups that can have limited access to care including:

  • Children and Adolescents: According to the Centers for Disease Control and Prevention, 13-20% of American children experience a mental health disorder in a given year. Of those, only 20% receive treatment. Cost can often play a role in preventing young people from receiving the care they need. Teletherapy can help make mental health care more accessible to children and adolescents, and may be more ideal for teens comfortable with technology that may desire a higher degree of anonymity in care. Additionally, teletherapy can eliminate the need to miss school to attend in-person appointments, providing less disruption to a client’s daily routine.
  • Older Adults: The American Association of Geriatric Psychology estimates that 20% of older adults experience some type of mental health concern. These conditions often co-occur with other physical health issues and can go undiagnosed. Older adults can struggle with the cost of mental health care, and may have difficulty travelling to appointments due to physical health concerns or lack of transportation. Teletherapy can address these struggles by allowing people to see their therapist remotely. Furthermore, Medicare’s telehealth benefit includes psychotherapy codes, making teletherapy more affordable for older adults.
  • Minority Groups: Minority populations have the same level of risk for mental health disorders, but access treatment at much lower rates. Mental health care is often less accessible to minority groups, and people seeking care often anticipate lower quality or experience language or cultural barriers when receiving treatment. By reducing geographic barriers, teletherapy can increase options for people when choosing a provider and help them find someone who is a good fit.
  • Rural Residents: According to the US Department of Health and Human Services, 60% of rural Americans live in a mental health provider shortage area. Combined with lower incomes, high levels of stigma, and a potential lack of anonymity in a smaller community, seeking care can be difficult. Teletherapy allows rural residents to access mental health services more privately with less travel.

We can begin to address the mental health care provider shortage by expanding the utilization and reach of current providers to underserved populations in need of services. Teletherapy is one way to do this, and it can be effective for treating many conditions. To learn more, download our tip sheet:

Download our free tipsheet

How to Improve Therapy Session Attendance, Reduce No-Shows & Cancellations

No-shows and cancellations for therapy appointments are more than just annoying, they can be detrimental to you, your clients, and your practice. If a client cancels a session at the last minute, or if they simply don’t show up, you’re not able to bill for that session, and you’re stuck with a non billable hour in the middle of your day that could have been filled with another appointment. In addition to being frustrating, studies have shown that high rates of cancellations can lead to diminished clinician confidence and affect one’s ability to provide effective care. Poor session attendance rates also impact clients, as they don’t receive the full benefit of therapy and can go on to struggle with persistent symptoms.

For many clients suffering from depression or anxiety, trying to improve their session attendance can be something of a catch-22 situation. Attending sessions can be made more difficult due to symptoms of their anxiety or depression, but in order to see improvement in their symptoms, they need to attend therapy. Clients may miss their first appointment due to a perceived stigma, or because they’re having difficulty taking the first step toward seeking help. Therapy can be a difficult experience, and often clients feel worse before they feel better, which can also lead to cancellations or no-shows if the individual does not experience immediate symptom relief. Alternatively, if they start to feel better, they may quit early and still miss out on the full benefit of in-person counseling. Other issues that can lead to cancellations, no-shows, and low session attendance include logistical concerns such as transportation, disability, or difficulty finding childcare or getting time off from work.

There are many ways you can improve session attendance at your practice, a lot of which aren’t expensive or labor intensive:

  • Give clients as much freedom in scheduling as possible. Giving more options for scheduling can result in fewer cancellations or no-shows.
  • Confirm appointment dates and times immediately after making the appointment with a printed card, so misreading handwriting or making a typo in a phone calendar cannot occur.
  • Give adequate appointment reminders in the patient’s method of choice: phone calls, text messages, emails, or postcards in the mail.
  • Offer rewards for attending sessions by giving discounts on bills, or penalties for no-shows or late cancellations. Create a clear no-show policy and work with clients to troubleshoot when they are struggling with repeatedly no-showing. Consider discharging clients who repeatedly no-show or cancel.
  • If a client no-shows for an appointment, follow up to find out why and reschedule promptly. You may notice patterns that can help you improve attendance in the future.
  • Offer video therapy sessions to your clients. Teletherapy can be a great way to lower the barrier to entry for those seeking help, and has been shown to be just as effective as in-person treatment for a variety of conditions.

Of these, teletherapy may be the most major change to make, but it can also be the most impactful. To learn more about how to bring teletherapy to your practice, and why it’s becoming more and more popular, download our free tip sheet.

Download our free tipsheet

Physician, Heal Thyself: The Importance of Self-Care for Mental Health Care Providers

It is well known that therapists (psychologists, psychiatrists, social workers, counselors) need to maintain good mental health in order to be effective. In fact, entire books have been written on the topic of how those in the helping professions can take care of themselves. The phrase “compassion fatigue” has been used to describe the phenomenon of psychological distress or indifference which arises in those who are repeatedly called upon to care for others, extend themselves emotionally, or generally support those who are suffering. The degree of compassion fatigue may relate to the severity of the suffering, or the frequency of these calls, though most seasoned clinicians have had at least a few moments when they felt “burnt out”. These experiences, though, should not go unnoticed or unattended to, as compassion fatigue or burn-out can result in diminished quality of treatment for clients or patients.

So why is it so hard for providers to heed their own advice and practice self-care?

Physicians often have not experienced the ailments they’re treating. However, if it is possible for a provider to walk in the shoes of the client, why wouldn’t they take that opportunity? Understanding what it’s like to call a therapist, navigate payments or insurance, even feeling what it feels like to wait in the waiting room of a mental health provider is worth doing.  Beyond that, actually using the therapy tools can help providers to better understand their work with their clients. Training seminars with experiential or participatory components are often the most effective and compelling because they give the provider a chance to really understand what it’s like to be a client going through the intervention. Having personally examined one’s core beliefs, or spent some time on building one’s own exposure hierarchy can enable therapists to be more effective when using these tools with clients. It opens one up to see the challenges and opportunities that exist.

This is not a novel idea. Indeed, Freud suggested that therapists engage in analysis and a survey study in 1994 examined therapists’ engagement in therapy. As the field has shifted to some degree, so have the types of therapy in which clinicians are encouraged to engage. There have been calls in the literature recently for psychologists to utilize mindfulness-based positive principles and practice and studies have found that MBSR interventions can be effective when taught to therapists-in-training.

Many providers describe feeling too busy as a primary problem, and feel that they don’t have the time for self-care. Often clinicians feel pulled in a number of different directions: direct client contacts, administrative tasks, note taking, supervision, etc. New technology tools, though, can help providers streamline some of their processes to increase efficiency and “make” time. Video conferencing software can save travel time to meetings, and EHRs and billing programs can reduce time spent on note-taking and administrative tasks. Additionally, new mental-health and wellness tools such as Pacifica can make engaging in self-managed CBT more engaging and time-efficient. Pacifica has a library of meditation and relaxation tools, customizable reminders for health behaviors, mood tracking, and a suite of thought record tools for reflecting on one’s own challenging moments. Taking a few self-care moments to check-in with yourself is important, regardless of which side of the room you’re sitting on.