4 Questions To Ask Yourself When Hiring a New Therapist

One of the wonderful challenges that comes from having an abundance of business is the need to add new additional clinicians to your practice. But how exactly do you know who will be a good fit? How can you be sure to make the best choice that will benefit both the clients and your practice? Not too long after opening Wasatch Family Therapy, I had created relationships in my community and built my online presence to the point that the demand for my services exceeded the supply I could provide. In other words, I needed to hire new therapists! Since I do not have a background in business, the process was entirely new to me, but thankfully I found that it happened quite naturally. I identified a few key criteria (beyond simply having required credentials and experience) that a candidate must possess in order for me to feel like he/she was a good enough match to hire. Here are 4 questions to ask yourself when meeting with an applicant who you may potentially bring in to your practice:

• Do I like him/her?  

It may seem obvious, but it's critical that you feel comfortable with an individual who may be working for you. If you do not like to be in his/her presence, why would a client? It goes without saying that people skills are invaluable in this profession; it's what we do! Look for someone who puts you at ease, is warm and inviting, and who you find yourself attaching with. Be mindful of the emotional climate of your practice; you want to bring someone in who will work well with others, avoid drama, and of course help clients through their emotional struggles. Whether or not I genuinely like someone is the most important factor determining if I hire him/her (interestingly, this same criteria is also usually first on the list of what a client looks for in a therapist).

• Were they born to be a therapist?   

When looking to add to my practice, I look for individuals who I can sense were born to do therapy. It's common for practitioners to work with a lot of graduate level interns, and there are a select few who truly stand out; people who are naturally thoughtful, reflective, and sensitive to others' needs and feelings. I want someone who's always had the intuition and instinct of a therapist who just had to go through the official training to actually become one.

• Are they emotionally stable?  

This question is admittedly a bit delicate. While no one has it all together all the time, it naturally follows that someone who has a handle on his/her emotional issues can better assist clients in managing their own. Good therapists often use difficult past life experiences to relate to and help clients, so being "emotionally stable" doesn't necessarily mean you've never struggled mental health or relationship problems; quite the opposite can be true! To use an analogy, you cannot be a tour guide for other people to places you've never traveled. Still, I need my therapists to be healthy in order to best serve our clients.

• Do they reflect the values of my practice?

As the owner of my practice, I need therapists who work for me to be similar to me in many ways. This is not to say, of course, that I am wanting someone with the exact personality, training, and expertise that I have. Still, there needs to be a continuity of approach and therapy style common to our clinicians. Throughout the years, we've had inquiring individuals wanting to see me specifically after hearing me speak or learning about me through social media. When I don't have an available opening to see someone new, I like to be able to state my confidence in another therapist and tell the prospective client that I've hand-selected a particular counselor that I wholeheartedly trust to do good work. I suggest that practitioners looking to hire new therapists identify a few specific values that are key to the philosophy and setting of their private practice to look for in applicants.

What do YOU look for when hiring new clinicians?

Let me know!

This post was adapted from an interview I did with Joe Sanok, LPC on" Practice of the Practice." Click here for access to the full podcast.

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HIPAA Security Rule Compliance for Private Practitioners

Guest Post by Rob Reinhardt, LPCS, Technology Consultant for Mental Health Professionals, CEO of Tame Your Practice

Wouldn't it be nice if someone would provide us with a brief checklist of things we need to do in order to comply with HIPAA (the Health Insurance Portability and Accountability Act)? I strongly recommend that you not wait for that to happen. HIPAA was purposely constructed to be flexible so that both large hospitals and solo practitioners would be able to comply. You wouldn't want to follow the same checklist as a hospital would you? Further, because HIPAA now covers electronic Protected Health Information (ePHI), it's important that it be flexible since technology continually evolves.

That said, there are some basic parameters and processes to be aware of. Once these concepts are understood, HIPAA no longer seems to be this overwhelming, unintelligible, monstrosity. It takes on a role similar to progress notes and other paperwork; that stuff that gets in the way of our client time, but we know we need to do it.

Here then, is a brief summary of the most important things to know about HIPAA:

It's More Than Just the HIPAA Privacy Notices

HIPAA started out in 1996 with the Privacy Rule, which regulates the use and disclosure of Protected Health Information (PHI) by Covered Entities (CEs). Protected Health Information is any data about health care that can be linked to a specific individual. Covered Entities are health plans/insurers, clearinghouses, and providers who engage in “Covered Transactions”. For most mental health clinicians, that means filing electronic insurance claims (even if you don't, be sure to read on). This is the part of HIPAA that brought us the HIPAA Notice of Privacy Practices, where providers detail for clients how and when they will use and/or disclose their PHI.

In 2003, the Security Rule was added in order to set standards for securing ePHI. It requires that CEs establish Administrative, Technical, and Physical safeguards to ensure the privacy of client data. This was further enhanced by the HITECH Act (Health Information Technology for Economic and Clinical Health Act) in 2009 and the Final (Omnibus) Rule in 2013.

I've found that most therapists have the Privacy Rule down pat, so in the following sections, I'll focus on clarifying information from the Security Rule.

HIPAA Security Compliance Is An Ongoing Process

One of the primary components of complying with the Security Rule is completing a Risk Analysis and Management Plan. This is a process of documenting reasonably anticipated threats to the security of ePHI (i.e. theft, loss, fire) and a plan for dealing with those threats. This is required to be reinforced through a documented set of Policies and Procedures (yes, even if you're a solo practitioner). Therapists wouldn't dream of assessing a client at intake and then never re-visiting that assessment. Similarly this Risk Analysis process needs to be re-visited on a regular basis. This ensures that new technologies and threats are addressed appropriately.

Software and Devices Can't Be HIPAA Compliant

If you listen to the marketing speak, you might get the impression that a CE can be in compliance as long as they choose software and devices that are “HIPAA Compliant”. The problem is that such things do not exist!

Only Covered Entities or Business Associates can be compliant with HIPAA by engaging in the processes described above. A Business Associate (BA) is any third party that a CE shares PHI with. This could be a billing agent, an EHR vendor, or a telehealth application vendor. In creating this relationship, the CE is required to establish a Business Associate Agreement with the BA, outlining the responsibilities of each. The good news is that, due to the Omnibus Rule, this requires that the BA is held to the same standards for compliance as the CE. To be clear, this doesn't release the CE from all responsibility. They still need to conduct a Risk Assessment. However, it's often the case (especially with EHR) that using a third party vendor will greatly decrease the scope of (read: amount of work involved in) the CEs process.

(Side Note: It's important to note that financial transactions are exempt from HIPAA, so typically financial institutions don't fit the definition of Business Associate. However, there are some circumstances to be aware of, such as some of the features offered by services like Square).

But I Don't Take Insurance So I Don't Have To Worry About HIPAA

It's true that, if you (or your billing representative) are not filing electronic insurance claims, you likely don't fit the definition of Covered Entity. Technically then, you don't have to comply with HIPAA. You should be aware of and consider the following, however:

• Standard of Care - HIPAA is becoming recognized as a “Standard of Care” when it comes to Privacy and Security. If how you handle privacy and security ever comes into question, there's a solid chance that HIPAA will be the measuring stick for whether you're doing a good job.
• Ethics – Our codes of ethics require that we keep client information confidential. In line with the first point, what standards can we use to prove that we are doing so, especially with ePHI?
• State Law – Be sure to understand your state laws regarding client privacy. If you're in Texas, for example, your state laws are in some cases even more stringent than HIPAA.
• Best Practices – Similar to the idea of Standard of Care, the set of requirements in HIPAA are considered “Best Practices” for securing client data. While HIPAA may seem bloated and overdone in parts, the core requirements make sense and are a good path for significantly reducing the risks to privacy.

Rob Reinhardt is a Licensed Professional Counselor Supervisor in North Carolina and CEO of Tame Your Practice. In addition to helping therapists integrate technology into their practice, he is the column editor for Counseling Today magazine and creator of Describe, a therapy tool appropriate for individuals and families of all ages!

3 Things Potential Clients Really Want to Know

We've spent thousands and thousands of dollars on graduate education, continuing education, advanced clinical trainings and years in practicum and under supervision. We have invested a lot in our credentials, and all of the impressive acronyms behind our names. PhD, LCSW, LMFT, RPT, CSAC, LPC  -- and the list goes on.

In my twenty plus years of practice, I have realized that what we value as clinicians is not necessarily the same thing as what those who are considering our services value. In fact, there are some principle criteria that we as clinicians need to meet in order for an individual to choose us as his/her therapist. Of course, there are exceptions. There are clients who are savvy to the ins and outs of mental health credentials, trainings, and certifications and are seeking help from someone in a specific discipline or with specific training. However, as a general rule, potential clients want to  answer "yes" to these 3 questions before they select you as their clinician.

1) Do I like you?  

A sometimes overlooked step of gaining new clients is your approachability. You can have advanced degrees and training, but if someone does not feel drawn to you initially, it's very unlikely he/she will choose you. And remember that not everyone will necessarily favor your particular style, and that's ok! Just as you are looking for an ideal client, he/she is looking for an ideal therapist.

One way potential clients may determine if they like you is by what they see of your online presence. What can someone learn about your personality from your photo(s) and you online content? How do you present yourself? All these can play a significant role in whether or not someone takes the next step in seeking your services.

2) Can I trust you?  

Trust is a critical aspect of the therapy process, and people may want to get an idea of how trustworthy they perceive you to be before becoming a paying client (we don't share our innermost struggles with just anyone). Are you someone who can be trusted with another's vulnerabilities and pain? Would potential clients feel comfortable confiding in you? Do they feel like you are someone who would value and care about them? Do they believe that you are a competent provider?

When it comes to building trust with potential clients, once again a strong online presence can go a long way. By viewing the content you post on your blog and/or social media platforms, they can get a sense of your level of credibility and trustworthiness, and you can begin the process of fostering trust even before a client's first session.

3) Can you help me?

You as a therapist are there to serve, and individuals interested in you want to know that you have the skills to help them. Understandably, potential clients will be willing to emotionally and financially invest in therapy only if they believe it will truly benefit them. Can you use your training and experience to help them problem solve or develop coping skills? Does your professional expertise match their therapeutic needs? The answers to these questions influence whether or not someone will choose you.

An individual may not be able to fully know if you can help him/her until therapy actually begins. However, your online presence can still play a factor in introducing yourself, your approach, and your therapy style him/her. For example, media interviews can help potential clients see you as not just a provider, but as an expert in your speciality area. This type of exposure allows others to see your level of skill and competence (read here for more about how media interviews can benefit your practice).

How can you present yourself so that potential clients-

• like you
• trust you
• know you can help them

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Therapist Turned Entrepreneur: Howard Spector, Founder and CEO of SimplePractice

I'm excited to introduce you to the kick off of a new series: Therapist Turned Entrepreneur and introduce to you a mental health professional who transformed his training into creating mental health related businesses. Howard Spector is a therapist turned entrepreneur and is the creator of TrackYourHours.com and more recently, SimplePractice management system. Here is his story:

Tell us about your background (college experience and degree, career beginnings, etc.). 

Wow, big question. I’ve had a number of careers as I tried to find the one that really fit. I attended USC for undergrad, and then after some years working in the entertainment industry found myself in Palo Alto while my wife was doing her medical residency at Stanford. I was always a bit of a technology geek and really connected with what was happening in Silicon Valley. We eventually ended up back in Los Angeles where I had some success with a number of technology companies. Then one day, I realized how disconnected I felt from the work I was doing and decided that I needed to reconnect with what was important to me, and also that a major career change was part of that. There was a particular school, Pacifica Graduate Institute, that I had always wanted to attend. Pacifica has a unique program where you basically live there for 3 days a month and are immersed in this wonderfully rich world of depth psychology. When I began school there, it felt like coming home. It was one of the most important experiences in my life, and I am very grateful for it.

With your business savvy and drive, you could have gone in many different directions. Why did you decide to apply your expertise to the mental health profession?

After graduating from Pacifica, I was doing my internship in California, and the Board of Behavioral Sciences (BBS) has very confusing rules for how you need to accrue, track, and report your 3000 hours of clinical experience. After fumbling around with a complex spreadsheet, I realized that this whole process would be better served by a web-based product. So I developed a product called TrackYourHours. It had all the BBS rules and forms built in, and it turned into a very sophisticated piece of software that was simple to use. It caught on quickly, and thousands and thousands of pre-license clinicians now use it. So that was where the entrepreneur in me really kicked in - I saw a need and filled it.

How did you come to develop the management system SimplePractice? 

I was getting close to completing my 3000 hours of training and started to look at practice management products to find one I would want to use. To be honest, I was very unimpressed by what was out there. Products were either outdated and just horrific to look at or too complex for me. I wanted something simple and intuitive. So I decided to build my own.

You’ve had tremendous success with your product. Explain some specific things you’ve been able to achieve with SimplePractice.

The most important thing for me is that our customers love our product for the reasons we set out to achieve - it’s simple and intuitive. I am also very proud of our team. We work insane hours to make sure we are adding the necessary features to our product so we can fulfill our promise to our customers. We are able to innovate very efficiently and are able to build out our product in ways that keeps new features well integrated and intuitive, as opposed to just slapping things on top of one another.

One of your main messages is the idea of “counselor as entrepreneur.” Why is it important for solo health practitioners to think of themselves as entrepreneurs? What are some ways that they can get into that mindset?

I don’t think this is limited to solo practitioners; it applies to anyone in any setting. I think the message that “you are an entrepreneur” provides the necessary reframe for this community. Being called to this special work is a gift, but that doesn’t mean this melding of art and science is not a business. It is very much a business, and one cannot survive and thrive by ignoring that. I want these health and wellness practitioners to embrace the business part of their practice and understand that as an entrepreneur/small business owner, there are things they can do to have greater success - and that that's ok.

One of our interests here at Private Practice Toolbox is helping counselors generate income in ways other than seeing clients. We’ve talked about speaking, writing, and teaching, but as of yet haven’t discussed software creation and development. Is there any specific advice or insight you can offer to tech-savvy clinicians thinking of venturing into that realm? 

The first thing that comes to mind is that developing software is a lot harder than it looks. There is so much detail work that has to be attended to, and there is no gray area; software is black and white. There are so many use cases for something as seemingly simple as recovering a lost password. For example, do you click on a ‘forgot password’ link and then send the user to a page to enter some information - what information? What if the user enters it wrong? Is there an error message? Where? What does it say? The list goes on…and on…and on.

I don't say this to be discouraging. I say it because based on my experience talking with customers, most don’t realize the work it takes to develop even mediocre software. So my advice is this: If you have an idea, by all means, pursue it. If it’s software-related, then find someone to work with who has experience developing software. And be prepared to spend money on good developers and designers. My mom has this great saying: “Cheap is expensive.” When it comes to developing software, especially software in the health market where there are significant security requirements needed to protect patient health information, don’t be cheap.

To recap: Follow your dreams and passions, and if that happens to be developing software, then understand the costs of time and money it takes to develop something valuable.

Not only do you have an innovative software program, but through your company blog, you are also involved in educating clinicians on how to best run their practice from a business standpoint. Why is it important for you to share your wisdom and skills?

Because I am incredibly passionate about this work. I have some insights into this field because I trained as a clinician, and I want this community to embrace the business side of their practice. The services clinicians provide are invaluable, and they should be well compensated for all the time they put into getting educated and trained. The more they think of themselves as entrepreneurs, and the more they can see the parallel between other industries and theirs, the more it will help them. I think I have more to offer than just a great software product, and if I can help clinicians, even ones that don't use SimplePractice, then that is awesome.

Howard Spector is the CEO and Founder of SimplePractice. He has years of experience creating and developing technology companies and was the creator of TrackYourHours.com. He has a MA in Psychology from Pacifica Graduate Institute and a BA from he University of Southern California. 

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Website: www.simplepractice.com

Blog: www.simplepractice.com/blog

Facebook: www.facebook.com/pages/SimplePractice/457351787631292

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3 Ways Managed Care is Hurting Your Practice

3 Ways Managed Care is hurting your

This is not the first time you've heard me share my perspective on the problems of building private practice based on managed care. The original intent of these third-party companies was to ensure equity for those who receive treatment, but the actual results have been far from successful and have caused a myriad of problems. Some have even described managed care as the cause of the mental health care crisis. And while managed care wreaks havoc on the field as a whole, this system is also problematic for private therapy practices. As a clinician, I can certainly attest to this. My guess is that you can too. Here are the 3 main ways that using managed care panels may be hurting your practice:

1) Micromanagement of Treatment

Managed care panels have a way of micromanaging you in a supposed attempt to make you accountable. This means that a therapist often has less say and control in the type, length, and modality of treatment provided to the client, who has also has less input in the process. Think about it: an outside, commercial middle-man is dictating how you, the professional, help your client. It's easy to see how such a system lends itself to inadequacy and substandard care.

The mandatory diagnosing of clients is arguably the most deplorable part of using managing care panels. You are often required to provide a diagnosis, even if you do not believe your client has one. Even worse, some companies only accept certain kinds of diagnoses, which only further restricts your ability to provide ethical and accurate information and care.

2) Business Inefficiency

Communicating with managed care companies is a nightmare. There's excessive paperwork to fill out and phone calls to make. The hassle is never-ending, and it takes away from what you want to do: use your professional skills to serve your clients. Not only is your business inefficient and time-consuming to operate, but by looking at the math, you'll discover that your overall costs are increased as well. Even analyzing things solely from a business perspective, it's evident that using managed care is not a desirable model.

3) Payment Problems

When working with managed care their contracted rates were 40-60% of my full fee. Not only was there a low fee, but there was also the frustration of denied or delayed payments. There would sometimes be problems with the paperwork, or things would get lost in the tedious communication, and I wouldn't get paid for weeks or even months. I wasn't being sufficiently compensated for my work, and I wasn't always being paid in a timely manner. It was disheartening to say the least. It is emotionally and financially draining, and we deserve better.

These are three of the major ways managed care can hurt your practice (although there are certainly more). Thankfully, there's a better way. A way you can work less and earn more. I'm excited to share you with in upcoming posts about how transitioning to a fee-for-service model helped me build a thriving practice.

Click here to access my webinar, "Breaking Up With Managed Care" to learn even more tips and strategies.

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