The Visionary Issue 2

THE VISIONARY

LEADING THE WAY IN GROUP PRACTICE INNOVATION

LETTING GO OF GROUP PRACTICE OWNERSHIP

10 WAYS TO WORK 10 HOURS LESS

PSYCHADELIC THERAPY TRENDS

ISSUE 2

HEALTHCARE HIJACK: INTERCOMPANY ELIMINATIONS FINDING BRAND CLARITY IN CHANGING TIMES

THERAPY IN THE METAVERSE

A NEW FRONTIER OF MENTAL HEALTH CARE

UNLOCK YOUR TEAM‘S FULL POTENTIAL AND STEP INTO YOUR VISIONARY ROLE

NEW BOOK LAUNCH! THE ACCOUNTABILITY EQUATION™

BRIDGING THE GAP IN ACCOUNTABILITY AND IMPACT BY: MAUREEN WERRBACH

AVAILABLE ON AMAZON

MAY 6, 2024

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THE VISIONARY

THE VISIONARY EDITOR MAUREEN WERRBACH

ADVERTISERS THE GROUP PRACTICE EXCHANGE Group practice strategist + consultant

WRITER MAUREEN WERRBACH Urban Wellness and The Group Practice Exchange, Group practice business strategist

CONTRIBUTING WRITERS

HR ANSWERS Fractional HR services C-SUITE BOUTIQUE Fractional Integrator services ANTIRACISM REVOLUTION A membership community for collective liberation

CHRISTOPHER BROWN Business Consultant, Group Practice Owner

CLINICAL SUPERVISION DIRECTORY A directory to connect clinical supervisors and supervisees

SHAELENE KITE Therapist, Group Practice Owner

PRODUCTIVE THERAPIST Work with our team of specialized mental health virtual assistants. Or let us train your in-house admin team.

ALICE SHEPARD Psychologist, Group Practice Owner URIAH GUILFORD The Productive Therapist SARAH BUINO Head/Heart Business Therapy Therapist, consultant, speaker, and teacher

GREEN OAK ACCOUNTING Accountants, tax professionals and bookkeepers that specialize in helping private practice owners.

TAKE CARE FRIEND Custom therapist-curated subscription box to remember your loved ones during life's hard moments.

@THEGROUPPRACTICEEXCHANGE #THEVISIONARYMAGAZINE WWW.THEGROUPPRACTICEEXCHANGE.COM

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IN THIS ISSUE 6

Mental Health in the Metaverse: A New Frontier of Mental Health Care

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Finding Brand Clarity in Changing Times

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Embracing The Exhale The Art of Letting Go in Group Practice Ownership

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Leading From A Grounded Presence: 5 Things To Stop and Start Doing As A Leader

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Healthcare Hijack: Navigating the Murky Waters of Insurance-Owned Mental Health Practices

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Navigating the Aftermath The Change Healthcare Cyberattack

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Psychedelic Therapy Trends & Pathways

Global Advocacy for Liberation as Visionary Leaders 10 Ways to Work 10 Hours Less Every Week

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FROM THE EDITOR

Welcome to the second issue of "The Visionary," a journey that has been as enlightening as it has been exhilarating. Reflecting on the publication of our inaugural issue, I am struck by the depth of learning and growth experienced in such a short span of time. The process of assembling a print magazine from the ground up has been a masterclass in patience, creativity, and resilience. More importantly, it has been a profound lesson in the value of diverse expertise.

In the realm of visionaries, learning is an unending journey. One of the most remarkable aspects of bringing this magazine to life has been the opportunity to engage with industry experts whose knowledge spans a wide spectrum of specialties, far beyond my own. This engagement has not only fueled my personal growth but has also shaped the magazine's ethos. It's a reminder of the magic that happens when different perspectives unite with a common purpose. I hope, as our readers, you find this exploration of diverse areas of entrepreneurship equally enriching and illuminating.

This issue delves into an array of compelling topics, each selected for its relevance and potential to spark dialogue. We explore the transformative power of psychedelic therapy, a frontier pushing the boundaries of traditional mental healthcare. Equally forward-looking is our examination of mental healthcare within the metaverse, an emerging space where digital and psychological realms converge. Yet, we also tackle the pressing realities of today, such as the intricacies and challenges of health insurance in mental healthcare.

In a reflective pivot, we share insights on the personal and professional journey of letting go of group practice ownership—a narrative about change, adaptation, and the courage to embrace new paths.

Through these varied topics, "The Visionary" aims to be a beacon for those eager to explore the future of mental health, whether through the lens of technology, policy, or personal growth. Each article, interview, and feature is crafted with the hope of inspiring our readers, encouraging you to see the vast potential for innovation and transformation in mental healthcare.

As you turn these pages, I invite you to embark on this journey with an open mind and a curious heart.

Let us delve into the unknown together, challenging preconceptions and fostering a community of visionaries. Your engagement, feedback, and stories are what make this endeavor worthwhile. Together, let's envision and shape the future of mental health.

Enjoy our second issue.

With gratitude, Maureen Werrbach, LCPC Editor-in-Chief, The Visionary

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MENTAL HEALTH IN THE METAVERSE: A NEW FRONTIER OF MENTAL HEALTHCARE

BY MAUREEN WERRBACH

The metaverse, a nascent blend of virtual and augmented reality, promises to revolutionize everything from gaming to commerce. But what about healthcare?

Could this immersive digital realm unlock new possibilities for mental health treatment, offering a transformative way to connect with patients and deliver care? While the future remains unwritten, the potential is undeniable, brimming with both opportunities and challenges for visionary mental health group practice owners.

Opportunities: Stepping into the Virtual Therapy Room Imagine a patient struggling with social anxiety practicing public speaking in a safe, virtual auditorium filled with customizable avatars. Or, picture an individual with a phobia confronting their fear of heights by gradually ascending a virtual mountain peak, with their www.thegrouppraticeexchange.com

therapist guiding them every step of the way. These are just a glimpse of the immersive experiences the metaverse could offer. Here are some key opportunities: Enhanced Exposure Therapy: The metaverse excels at creating controlled, customizable environments ideal for exposure therapy, a core technique for treating phobias, anxiety disorders, and PTSD. Virtual simulations can offer an unparalleled level of control over triggers, enabling gradual and safe exposure, while data analysis within the metaverse can track progress and adjust the experience accordingly.

Increased Accessibility: Imagine therapy sessions readily available regardless of geographical location or physical limitations. The metaverse eliminates travel barriers and can cater to individuals with mobility issues through embodied avatars. This democratization of access could bridge the gap for 05

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underserved communities and individuals struggling with transportation or physical limitations.

Creative Interventions: Beyond traditional talk therapy, the metaverse opens doors to innovative interventions utilizing the full potential of its digital landscape. Imagine art therapy sessions within fantastical, everchanging landscapes, group support sessions in calming virtual nature scenes, or mindfulness exercises guided by AIpowered avatars in tranquil digital havens.

Enhanced Engagement and Motivation: Gamification elements like avatars, progression systems, and interactive experiences can foster engagement and motivation, especially for younger generations accustomed to immersive digital environments. This can lead to improved adherence to treatment plans and ultimately better outcomes.

Data-Driven Insights: The metaverse generates a wealth of data on user behavior and interactions within the virtual environment. This data can be used by therapists to gain deeper insights into patients' experiences, track progress, and personalize treatment plans more effectively.

Challenges: Navigating the Uncharted Territory While the metaverse holds immense potential, it also presents significant challenges that need to be addressed before it can fully revolutionize mental health care. Here are some key points to consider: Ethical Considerations: Issues like data privacy, security, and potential discrimination based on avatar appearance need careful consideration and robust ethical frameworks. Additionally, the potential for addiction to these immersive experiences and the blurring of lines between reality and virtuality demand close attention.

Technological Barriers: Not everyone has access to VR headsets and high-speed internet, creating potential disparities in access. Additionally, technological glitches and limitations could disrupt therapy www.thegrouppraticeexchange.com

sessions or create uncomfortable experiences for patients.

Therapist Training and Adaptation: Providing therapy in the metaverse requires specialized training and adaptation of existing therapeutic approaches. Therapists need to learn how to navigate the virtual environment, utilize its tools effectively, and adapt their communication style to cater to the unique dynamics of VR interactions.

Regulation and Standards: Currently, there are no clear regulations or standards for providing mental health services in the metaverse. This lack of oversight raises concerns about the quality and safety of care and necessitates collaboration between stakeholders to establish ethical and best practice guidelines.

Human Connection and Empathy: Can the therapeutic bond and genuine human connection, crucial for effective treatment, be replicated in a virtual environment? This is a question that needs further exploration and careful consideration.

The Road Ahead: Building a Responsible Future The metaverse represents a fascinating crossroads for mental health care. While the possibilities are exciting, navigating the challenges requires a nuanced approach. Collaboration between mental health professionals, technologists, policymakers, and ethicists is crucial to ensure responsible development and implementation of metaverse-based interventions.

For visionary mental health group practice owners, the metaverse presents a unique opportunity to pioneer this new frontier. By carefully considering the ethical implications, investing in therapist training, and advocating for responsible development, they can play a leading role in shaping a future where the metaverse becomes a powerful tool for promoting mental wellbeing and improving access to quality care.

Remember, the metaverse is not a replacement for traditional therapy but rather a potential tool to enhance and expand its reach. As we cautiously step into this virtual landscape, let us prioritize our human values, prioritize patient safety and well-being, and ensure that technology serves as a force for good in the realm of mental health.

References: 1. https://pubmed.ncbi.nlm.nih.gov/36458297/ 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568191/ 3. https://intelligence.weforum.org/topics/a1G680000008gweEAA

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The Accountability Equation™ Learning Curves for Visionaries As They Bring On An Integrator 01

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Delegation & Trust

Strategic Thinking

Empowering the Integrator

The business owner needs to learn

As a visionary, the business owner

Learning to empower the integrator

how to delegate responsibilities to

focuses more on the long-term

to make decisions and take

the integrator and trust them to

vision and strategic direction of the

ownership of their role is crucial. The

manage day-to-day operations. This

company. This involves learning to

business owner should create an

shift from hands-on management to

think strategically, set clear goals,

environment where the integrator

a more strategic role requires a level

and guide the integrator in aligning

feels confident and empowered to

of trust in the integrator's abilities.

operational activities with the overall

implement strategies without

vision.

constant micromanagement.

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Communication of Vision

Balancing Innovation & Stability

Effectively communicating the

Striking the right balance between

company's vision, mission, and

innovation and maintaining stability

values to the integrator is a learning

is a key challenge for the visionary.

process. The business owner needs

The business owner needs to learn

to ensure that the integrator fully

how to encourage innovation while

understands and embraces the

ensuring that operational processes

long-term goals and objectives.

run smoothly.

The Accountability Equation™ Learning Curves for Integrators As They Step Into Their Role 01

02

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Operational Alignment

Building Relationships

Implementing Strategic Plans

Learning to align day-to-day

Establishing relationships with

The integrator needs to learn how to

operations with the visionary's

various teams and departments is a

translate the visionary's strategic

strategic goals is crucial. The

key aspect of the integrator role.

plans into actionable steps. This

integrator needs to ensure that the

Learning how to collaborate

involves creating and executing

operational activities contribute to

effectively and build a cohesive

operational plans that align with the

the overall success of the business.

working environment is part of this

overall vision.

curve.

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05

Managing Change

Decision Making Authority

Integrators often need to implement

Understanding the extent of

changes in processes and workflows.

decision-making authority and when

Learning how to manage resistance

to escalate decisions to the visionary

to change and ensuring a smooth

is part of the integrator's learning

transition is part of the learning

curve. Striking the right balance

curve.

between autonomy and collaboration is important.

FINDING BRAND CLARITY IN CHANGING TIMES

BY ALICE SHEPARD, PH.D. 09

THE VISIONARY

It takes years of study to pass the Knowledge exams to become a London taxi driver. These tests measure one’s ability to navigate the city’s paved streets that sprang up from once well-hewn village paths. Such is the organic process of the birth of a great metropolis. Like the complicated roadways of London, many group practices begin small as solo practitioners, and slowly expand over time, constructing their brand narrative along the way. This method differs from having an established, well-funded business plan with a clear brand identity. As a result, there may be more than a few points along the way to a thriving group practice when the owners and their leadership teams feel lost or overwhelmed. If this describes you, be encouraged.

If honing a clear brand identity has been challenging, remind yourself of two key facts: first, that your work as a mental health professional is needed, and second, that this field is unlike any other. Mental health concerns are more complicated and nuanced than what a purely medical model or corporate branding approach can hope to explain. One’s group practice is a natural outgrowth of your areas of education, strength, insight, internal navigation, and wisdom. Your years of study, direct client care, publications, research, case presentations, teaching, and supervision have enabled you to become a group practice leader. The clarity of your business is, at its core, a reflection of your core values.

Yet only some group practices have taken this homegrown route. The pandemic radically shifted the landscape for behavioral health care. The global health crisis increased the need for mental health services, and its universal impact reduced the stigma,

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heightening demand. Simultaneously, the pandemic heralded the rapid transition to online therapy, thus broadening the reach and accessibility of services globally and increasing the supply potential. According to Yahoo Finance, in 2022, the global market for mental health care was estimated at USD 375.21 billion and is forecasted to reach 532.86 billion by 2030.

(See https://finance.yahoo.com/news/532-billionmental-health-market-144800771.html.)

The unprecedented confluence of 1) increased demand for mental health services and 2) reduced barriers to delivering services spurred by tech innovation caught the interest of venture capital (VC) funders. According to Forbes magazine, “there is no slowdown in sight for VC-backed mental health startups.”

(See https://www.forbes.com/sites/katiejennings/ 2021/06/07/venture-funding-for-mentalhealth-startups-hits-record-high-as-anxietydepression-skyrocket/?sh=b0f1bcb11165.)

These VC-backed billion-dollar mental health startups sprung forth with clearly constructed branding. Most of the messaging stems from a more corporate, investor-focused mindset. A recent marketing pop-up window for one of these massive mental health companies invited employers to sign up for a call with two business acquisition leaders, clearly stating that neither had any mental health training.

So, where do small-to-midsize group practices fit in, and have we already been eclipsed? The answer is no. We are community-oriented and provide training and specialized services tailored to the real needs of our clients. For us, finding brand clarity is more important than ever because it represents owning our

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“Finding brand clarity is both an internal and external process.” iexpertise and stepping forward as thought leaders in a sector that has taken on an almost speculative frenzy. Despite any downside, tech innovation and increased demand for services result in a tremendous opportunity for small and midsized group practices to secure funding, increase their human-centered reach and impact, and reclaim the role as industry drivers.

So, how can we stand out in a marketplace that is becoming more crowded? Many mental health startups are advertising platforms for 1099-independent contractors with little or no common purpose, training, or objective. In sharp contrast, small to midsize group practices contain deep knowledge and a commitment to educating those earlier in their career path, not just hiring. Meanwhile, larger mental health businesses can feel overly corporate and cold. A solid group practice’s leadership provides community, skill, and oversight. Small group practice culture deepens client engagement and offers substantive care.

Finding brand clarity is both an internal and external process. The clarity of vision of who we serve and why will bring talented therapists who share your passion for wanting to work for you and create a clear interest in clients who feel seen and heard. It is essential to ask the following questions regularly as you continue

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to carve out your brand image: 1) What are you looking to create? 2) Who are the clients you most want to serve? and 3) What is the best way to communicate your offerings to them? Although many practices say that they address issues of anxiety and depression, this often underwhelms the therapy seeker.

Unfortunately, sites like Psychology Today and Zoc Doc have simple checkboxes that lack nuances about how your practice differentiates itself. Specificity matters. Brand clarity begins when group practices can amplify their voices through tailored services, approaches, and messaging to reach the most people in search of their vision and expertise.

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EMBRACING THE EXHALE

THE ART OF LETTING GO IN GROUP PRACTICE OWNERSHIP

By Sarah Buino, LCSW, CADC Take a moment to center yourself before you read this piece. Are you ready? First allow your exhale to release all the air out of your lungs. Next, allow your breath to fill your belly and your chest before releasing it out of your mouth. I invite you to let the exhale carry you as we dive into the concept of letting go.

This piece is born out of current conversations with befuddled practice owners. There are unique challenges to modern group practice ownership and many owners are flirting with no longer owning their practice. I’m here to tell you it’s ok to let go.

Hi, I’m Sarah Buino. I was a group practice owner for nearly ten years before selling to my Executive Director in early 2023. I survived the roller coaster of practice ownership before ultimately deciding to step off the ride.

And the persistent question that echoes through all my consultations is, “How did you know you were ready to let go of your practice?”

The inquiry transcends beyond “to own or not to own.” But our relationship with this concept of letting go is twisted in layers of emotions, traumas, and relational complexity, particularly in our professional domain.

As therapists, we are no stranger to the concept of letting go. The topic proliferates in many psychologyadjacent industries including self-help, spirituality, and addiction recovery. More than likely, we’ve guided our clients through investigation of various personal issues, supporting their recognition of what is no longer serving them. We’ve witnessed the relief and transformation experienced by clients who are able to release their grip on people, places, or things that cause them harm. But do we allow the same grace for ourselves as practice owners?

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Practice owners embody resilience and determination, honed through the experiences of our past.

Our formative years create a blueprint for how we navigate our family of origin, school, and eventually work. For a personal example, I earned my tenacity and stick-to-it-ness as a parentified child. In our capitalistic, achievement-oriented society the skills of parentified children are lauded.

“Make it work” is not just a clever Tim Gunn catch-phrase, but how many of us kept ourselves safe.

For myself, excelling in school and theater/music was my antidote to counter the lack of emotional safety at home. The eventual translation from academic success to business ownership was a nobrainer…until I hit emotional walls for which I was unprepared.

Four years into practice ownership, I was approached by a mentor to join forces and create an addiction intensive outpatient program. I was honored to have been chosen by someone I so greatly admired. I believed my connection with him elevated my career, so I was eager to solidify a public endeavor with him. Fast forward several months…despite broken promises and a profound lack of resources, I tripled my staff and launched the IOP. Colleagues remarked that I must be Superwoman to pull off this feat. But that successful facade masked crippling insomnia, relentless high anxiety, and mysterious new health problems. My lack of capacity negatively impacted the treatment of patients and staff. To top it off, I was not receiving financial compensation for this extra work. When my spouse rightly pointed out that maybe it was time to let go, I dismissed his concerns asserting that it would get better with time. Then as reality slowly crept in, the decision to let go felt akin to filing for divorce the day after a wedding. If I decided to end this venture, I feared facing complete professional humiliation. But finally, after nearly a year of working 80-hour weeks burning myself to a crisp, I chose to close the IOP and end my working relationship with this mentor.

In retrospection, we all harbor the sentiment of “if I only had known…” But no amount of fantasizing of having known better resolves the perils of ownership.The elixir lies in embracing the act of letting go. If only I had known the necessity of relinquishing the idyllic vision of my practice. If only I had known the inevitability of failure. If only I had let go of the desire for continuously happy employees. If only I had known that projecting an idealized self comes at a cost. Not even an MBA can prepare us for these bitter truths – letting go is always an emotional process.

The parentified child in me was trained to believe that holding on is a virtue and letting go is surrender or weakness. I was raised to believe that I should sacrifice myself for the comfort and happiness of others. Yet, at what expense did I cling to these principles within my business? It was only through introspection and honest reflection that facilitated the unearthing of discernment, distinguishing between self-preservation and self-neglect, allowing me to summon the courage to release what no longer served me.

In conversations with current practice owners, they share reflections of my journey as well, though maybe without the dramatic flair. They tightly clutch tasks such as bookkeeping or billing out of perceived fiscal prudence. They maintain toxic employees because they believe in second chances

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They maintain a business even after losing their passion because they feel they HAVE to keep going. But beneath these seemingly pragmatic choices lies a toll.

As you read this, can you sense a facet of your professional life that yearns to be set free? Group practice ownership can be a self-imposed incarceration constructed of people-pleasing, financial insecurity, and hubris. Once more I ask you to weigh the costs for yourself.

As you consider the costs, I invite you to reconnect with your early aspirations for your business.

Were they dreams of healthy workplaces, financial freedom, or better work/life balance? If you’ve achieved these dreams – celebrate yourself! Yet if the chasm between aspiration and reality feels immense, this may be a clue urging you to release something.

Often, it’s not obligations or the practice itself we must release, but rather ideas or illusions. We may adhere to rigid ideals, punishing ourselves when those ideals are unreachable. The dissonance between what we want and what we have can keep us locked in a bind where we feel stuck and helpless, when all along we have the power to free ourselves of these expectations if only we shift our perspective.

In other instances, it is crucial to let go of tangible obligations or tasks. Are you truly indispensable or can you relinquish control in exchange for mental freedom? What may change if you embrace the notion of valuing time and mental wellness above the ephemeral allure of financial savings?

And in certain cases, true liberation means relinquishing the business altogether. Letting go of the business also requires shedding titles, responsibilities, and the confines of self-imposed identities.

For me, the decision to part ways with my business stemmed from a revelation that my professional mission is to help therapists heal. And for various reasons, practice ownership was blocking me from this purpose. Blossoming into my truest self required a dissolution of the obligation and perfectionism to which I had formerly aspired. This letting go made space for work that feels more resonant for who I am now.

Letting go also requires grappling with discomfort — shame, fear, guilt and other emotions we attempt to evade. Yet amidst this discomfort lie opportunities for growth and pathways towards our most actualized selves. We are therapists. We know how to tolerate discomfort. We do it so well when helping others, but neglect to turn the compassion back towards ourselves.

So, my dear friend — allow yourself to slow down and ask the tough questions about how you’re doing, what’s working/not working, and ultimately what you want for yourself. Which aspects of professional life spark joy and which cause dread? Illuminating these answers with honest reflection is the first step to liberation.

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Let’s end with another breath. In this first exhale, imagine a release of all the stale air in your lungs. Allow the exhale to create space inviting clarity and discernment. Next, instead of intentionally inhaling, allow breath to breathe itself. The first exhale creates a natural vacuum in which the in-breath will naturally flow. The breath is inevitable, we don’t have to force it. Let the final exhale serve as a harbinger of wisdom, guiding you back to yourself.

Carry the exhale as a metaphor for the next phase of your business. May the exhale accompany you on your journey, illuminating your path to authenticity and fulfillment.

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GLOBAL ADVOCACY FOR LIBERATION AS VISIONARY LEADERS

BY MAUREEN WERRBACH

As mental health providers, we stand in a unique position — at the intersection of personal healing and societal transformation. Our ethical commitments extend beyond the therapy room, and is arguably intertwined with a global imperative to challenge oppression and advocate for liberation.

Lately, I've found myself in deep reflection on my role, both personally and as a business leader in mental health, through an anti-oppressive lens. The horrific events unfolding in places like Palestine, Congo, Sudan, and Yemen have been a stark reminder of the interconnectedness of our struggles and the pervasive nature of oppression. True liberation practice demands more than just introspection and action within our immediate professional environments. It requires a global focus. The reason for this is simple: Oppression knows no borders. The forces that marginalize and inflict suffering on people in one part of the world are always interconnected with systems of inequality and injustice elsewhere. To commit to anti-oppression is to understand that our fight against these forces must be as boundless as the systems themselves. In the following paragraphs, I’ll share my thoughts around global liberation, advocacy, and our role as visionary leaders, along with some reflection questions. I hope it helps strengthen your stance and actions as a visionary leader.

Why Advocacy is Essential as Visionary Mental Health Leaders Advocacy is the heartbeat of progress. It challenges the status quo, confronts injustices, and paves the way for more equitable societies. In the

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realm of mental health, advocacy transcends the boundaries of individual therapy sessions, influencing policies, and fostering a culture that recognizes the dignity and rights of all individuals. It's about giving voice and power to those that are marginalized. How can we not, then, focus on the global impact of oppression? How can we not see how it also affects our employees, clients, and communities at home?

Therapy as a Political Act I’ve heard more than one time from therapists that politics have no space in the therapy world. Therapy is often viewed through the lens of personal development and healing, focused solely on the person(s) in front of the therapist. However, its implications run much deeper. By addressing the physical and psychological scars left by oppression, therapy becomes a radical act of resistance. It not only helps individuals navigate their trauma but also empowers them to stand against the systemic forces that perpetuate their suffering. In this light, therapy is undeniably political, a means of challenging and changing oppressive systems. In a time where there is divisiveness and polarity in the therapist world when it comes to global advocacy for the oppressed, I am reminded of the beginning of my antioppression journey when I felt scared to call in others or be called in myself.

Be scared, but do it anyways. As business leaders in the mental health sector, we have privilege in the form of business ownership and leadership.

We must use that privilege to lift those voices and call awareness to oppression. Because, as I’m continually learning, oppression anywhere is linked to oppression elsewhere. Advocating for the oppressed, whether across

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the ocean or on the other side of the world is not only aligned with antioppression values, it breaks down oppression everywhere.

How can we, as leaders in mental health group practices, integrate an understanding of global injustices into our therapeutic approaches to make therapy a more politically conscious act?

Reflect on a time when a global event impacted your therapeutic work. How did this experience change your perspective on the role of therapy in addressing systemic oppression?

The Imperative to Use Our Voices As leaders in the mental health field, our voices carry weight. They have the power to shape discourse, influence policy, and challenge societal norms. Staying silent on issues of oppression and injustice not only contradicts our ethical obligations but also undermines our role as advocates for mental health. It is crucial, then, that we speak out against systems of oppression, both within our immediate environment and in the global arena. Issues like lacking resources, food insecurity, physical displacement, and violations to human rights directly affect the mental health of the people experiencing the oppression. Our advocacy should aim to dismantle barriers to mental health, challenge stigma, and promote policies that support the well-being of all individuals, especially those marginalized by oppressive structures. This involves critically examining our own practices and institutions, advocating for equitable mental health care, and supporting movements that fight against oppression globally.

By leveraging our expertise and platforms, we can contribute to a collective effort to reshape societal structures in ways that promote justice, equity, and healing.

In what ways can mental health leaders amplify the voices of those affected by global oppression and injustice, within and beyond the therapy room?

Consider a global issue deeply affecting you or your practice. How can you use your professional platform to advocate for change regarding this issue?

Ethical Foundations and Anti-Oppression Our ethics as therapists mandate a commitment to do no harm and to work towards the welfare of our clients. This ethical framework, however, also compels us to recognize and confront the broader systems of oppression that impact mental health. Valuing anti-oppression and liberation within our practices means acknowledging that mental health cannot be disentangled from the social and political contexts that shape individual and collective experiences. It is our duty to understand how these systemic forces operate and to actively resist them.

we serve but in pursuit of a broader societal transformation.

In what ways might embracing discomfort as a mental health group practice leader lead to more effective advocacy against global oppression?

Think about a situation where advocating for global justice would cause discomfort in your professional setting. How would you navigate this challenge to uphold your commitment to anti-oppression?

Visionary Leadership in Action As visionary leaders in the mental health field, we have a pivotal role in using our voices to effect change. Silence and inaction are luxuries we cannot afford, especially when faced with the dire realities of communities in Sudan, Palestine, Congo, Yemen, and beyond. By actively speaking against injustice, providing support through our work, and collaborating with organizations dedicated to these causes, we demonstrate our commitment to global mental health and human rights. Here is where our Visionary role can thrive. As visionaries, our skills of creativity, leadership, vision and value building, and creating action are at the center of what we do. We are in a unique position, one of power and privilege, that gives us the opportunity to advocate for real global change.

Identify one global issue related to oppression that resonates with your practice’s values. What concrete actions can your practice take to address this issue on a global scale?

Reflecting on your leadership journey, how can you further embed a global anti-oppressive perspective into the vision and mission of your mental health practice?

Conclusion As therapists and leaders in this field, we have a unique responsibility to use our voices and influence to challenge and change systems of oppression worldwide. Doing so is fundamental to the pursuit of mental health and wellbeing. By embracing advocacy, using our voices courageously, recognizing the political nature of therapy, and committing to a practice rooted in antioppression and liberation, we can play a critical role in the global movement toward freedom and justice.

How do our ethical obligations as mental health professionals compel us to confront and act against global systems of oppression?

Reflect on an aspect of your practice where you feel you could do more to incorporate anti-oppressive principles. What steps can you take to address this?

Visionary Leadership and the Duty to Discomfort As visionary leaders in the mental health field, embracing our role means using our voices boldly, even when it discomforts the oppressor or ourselves. Committing to anti-oppressive and liberation-focused practice requires us to challenge societal norms and engage in difficult conversations. It’s about recognizing that true progress sometimes necessitates unsettling the comfortable dynamics of power and privilege.

Our silence in the face of injustice only serves to perpetuate oppressionsomething we are seeing very clearly these days. Therefore, we must speak — loudly, clearly, and persistently — not just in defense of those . www.thegrouppraticeexchange.com

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10 WAYS TO WORK 10 HOURS LESS EVERY WEEK By: Uriah Guilford, MFT You have a big vision.

To be honest, it feels overwhelming at times.

You want to make a genuine impact and grow your group practice. You want to create an amazing culture that allows your therapists to grow and do their best work.

You also want to build a life that you love, but sometimes that doesn’t feel remotely possible.

Starting and scaling a group practice is no joke.

The workload and pressure is intense. So many needs, so many sacrifices to be made. It feels endless.

What if you could make your big vision a reality, while working 10 hours less every week?

I believe that it’s possible for you to get more done, so you can have more fun. To build a practice AND a life that you love.

I get excited just thinking about these ideas!

Let’s put on our creative visionary hats and dream up some exciting possibilities together.

Here are 10 ways you can work 10 hours less every week.

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1. Stop doing clinical work

delegate those things to a competent person. It will cost money, but it’s 100% worth it.

You’ve already decided to hire more therapists and grow your group practice.

4. Stop doing marketing work

As you expand your team and get their schedules full, you can choose to see fewer and fewer clients yourself. At some point, if you want to, you can stop seeing clients altogether and just manage your group practice. It’s challenging to decrease your caseload, but it’s definitely possible. Finding the right balance between clinical work and business work is essential.

2. Stop providing only 1:1 services This can apply to you as well as the therapists in your practice.

Start by offering group therapy. This can easily replace three or four individual therapy sessions with one group. The math works out nicely and equates to more money for less work! Offering groups is not the only option;. there are a number of things you can do to move your services from one-to-one, to one-to-many. You might want to create a membership site, an online course, a therapy intensive, or a couples retreat; to mention just a few ideas. The options are only limited by your creativity! Find something that takes you and your therapists beyond delivering services to just one person at a time.

3. Stop doing admin work Ultimately, you want to free up your time, so you can get more done and have more fun.

A good place to start is getting a virtual or inoffice assistant who can handle all your incoming referrals, back office tasks, and much more.

There are so many wonderful resources available for therapists in private practice. You simply have to find the ones that fit best with your needs and your budget.

There are other administrative roles and tasks that you can delegate. This includes billing, credentialing, bookkeeping, payroll, human resources, personal assistance for you, and the list goes on. You’ll get a huge return on investment when you stop doing admin work and

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You may or may not be a person who loves marketing work.

If not, this is for sure something you should delegate. Even if you truly enjoy marketing work, it might be something worth handing off. This includes all types of marketing tasks, such as paid advertising, social media, blogging, email marketing, and search engine optimization. One of the things I’ve been working on is fully outsourcing all the marketing for InTune Family Counseling to my team at Productive Therapist.

They are now writing monthly blog posts, turning them into social media posts, and then email campaigns to send to our list. Even though I enjoy doing marketing work and have done it for so long, it makes sense for me to step out of that role.

5. Stop doing repetitive work This includes anything that you're doing on a regular basis that can be automated.

You can leverage technology tools to get things done quickly and consistently, without lifting a finger. This usually involves using the features of your electronic health record system to handle things like charging credit cards, sending appointment reminders, sending invoices, statements and superbills. Even though I love playing with tech and software tools, it always takes quite a bit of time to fully learn all the features of a platform. I have found that this is almost always time well spent.

6. Stop doing unnecessary work If there are things you're doing regularly that aren’t helping you get closer to your goals, just take them off your to-do list or your calendar.

Super easy! This can apply to current or planned projects as well. Occasionally, I like to review my calendar and all of my recurring meetings. I reconsider each one and ask the following three questions.

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Is this something I need to do?

Is this something I should do?

Is this something I want to do?

7. Stop doing leadership work Once you've had your practice for a while, you can start mentoring other team members and placing them into leadership roles.

This might involve hiring (or promoting) a clinical supervisor, a practice manager, a site supervisor, or even an executive director. I know some practices also have roles related to community networking, training, culture, and quality assurance. When you have a big vision, you will need leadership support to reach the full potential of your practice. Good leaders have vision and inspire others to help them turn vision into reality. Great leaders create more leaders, not followers. Great leaders have vision, share vision, and inspire others to create their own.” Roy T. Bennett, The Light in the Heart 8. Stop doing chore work All of us have things in our personal lives that take up too much of our time and energy. Many of these can be delegated.

Business owners often don’t think of getting help in their personal life or they might feel a sense of guilt doing so. I’m talking about hiring a landscaper, a contractor, a nanny, a housekeeper, a math tutor, or even signing up for a meal delivery service. Consider the things that are taking up the most time in your day-to-day life. Can you get help with one or more of them?

It’s super smart to buy back your time with money.

could put a full leadership team in place and have very few responsibilities. Maybe you want to grow your group practice with the intention to sell it and use those funds for your retirement. You have options. Eventually, you will want to fully retire and have zero work obligations. Doesn’t that sound nice!? If you’re thinking the same, you might need a vacation soon!

10. Add your creative idea here What else can you think of to decrease your work hours on a weekly basis?

A few creative ideas could be the ticket to getting you unstuck and making more satisfying progress towards your goals.You’re not likely to cut 10 hours out of your week overnight. It’s a gradual process.

However, the more you build a team, delegate, and streamline your operations, the closer you will get to your dream lifestyle. Soon, you will find yourself in a position where you have a ridiculous amount of free time. So much so, that you might need to find a new hobby, do some volunteer work or just get comfy on the couch and catch up on your favorite shows!

Imagine the possibilities!

So, what changes will you make this week?I would love to hear your ideas. Shoot me an email at uriah@productivetherapist.com. I will read and respond to every one.

9. Stop working entirely I'm sure you've given some thought to retirement.

Or maybe, it’s something you avoid thinking about! You can only do that for so long.

At some point, you're going to want to stop working entirely, or decrease your work hours significantly. Maybe you want to grow your group practice to the point where you own it, but you’re not involved in the day-to-day operations. You

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Leading From A Grounded Presence:

5 Things To Stop and Start Doing As A Leader Shaelene Lauriano Kite, LPC, RYT, DBT-LBC

THE VISIONARY

“Personal best, professional best in the last 90 days… Shaelene, you’re next”. It was October of 2023; during the check in of a quarterly meeting with my leadership team. I didn’t even try to muster up the white lie of something I felt proud of over the last quarter, because the truth was, I had nothing.

My well was dry. Though, I don’t remember exactly what I said, I vividly remember what I did, and how I felt.

As I tried to string words together, my voice cracked, and tears started flowing. I opened up and let words pour out. My team staring back at me with wide eyes. I remember thinking, “Shaelene, are you kidding me right now? Crying?”, But, it didn’t matter.

The faucet was open, and my truths came out.

For the next fifteen minutes or so, I shared my honest and most tucked away feelings about being a group practice owner. I shared about my exhaustion, my fears, my guilt, my frustration, and, my shame. I shared that I felt trapped in a sickening cycle that I didn’t know how to get out of. It was the first time I looked to those who were right behind me in the ship I was sailing and said, “hey guys, I actually don’t know what to do next, and i’m worried that we are lost in a bad storm.” It was raw, it was real, and let me tell you, it fucking sucked.

In my clinical work, I know to prioritize therapy interfering behaviors to ensure that my work with clients has a chance. I know the therapy will work, if it’s not interfered with. Things like lateness, non collaboration, a deficit in skills or commitment, etc. are all factors that need to be addressed directly.

This makes perfect sense to me and in my clinical, I know exactly what to do when they show up. But what about the business interfering behaviors of a group practice owner? What are those behaviors and how do they threaten the very things I was working so desperately to change? With tension in my body, and hot tears in my eyes, I started to name what I knew to be true as behaviors that needed to shift as soon as possible. I shifted my perspective of the problem being “my practice”, and moved towards targeting myself directly. A mini treatment plan for myself as a business owner. Here are the target behaviors I worked on decreasing.

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Business Interfering Behaviors of a Practice Owner: Checking, checking, and more checking. I was checking the intake log an obscene amount of times. Checking the EHR calendar frequently to look at scheduled session numbers. Checking Facebook Therapist Group pages so frequently that my thumb knows the automatic pathway. Checking emails repeatedly, despite knowing nothing has changed.

Curiosity and Comparison. Out of curiosity, I would look at other practice owners employment and compensation packages to see where ours size up, where ours stand.

“Playing” with the Profit First spreadsheet percentages. Seeing how much less I could manage paying myself. Waiting to see if the numbers magically shifted to add some extra zeros to the figures (I feel ridiculous writing this, but it’s true!).

Meddling with my team's work. I would ask random questions throughout the day about what was happening with x,y,z (cue urge to vomit).

An embodied sense of reactivity and urgencyI would give short, defensive answers and explanations to neutral questions about my business. Bottled up energy that was difficult to tolerate. Instead of sitting with it and taking care of myself, I reacted with meaningless behaviors to temporarily soothe that need to hurry up and do something to fix it.

Looking back now, it's kind of funny how much I would cling to these behaviors as a way to regulate all the hard feelings that came with the practice owner growing pains, but it’s also sad! Here I was with a successful practice and so many things that I had worked so hard for and I heard myself say out loud, “had I known, I wouldn’t have chosen this”.

That broke my heart! Not only did these behaviors feel awful, I realized they were also stifling the practice. When the captain of the ship is running around like a nut to the boiler room, then checking in on food service and then entering the stage to sing a song and dance for the nightly

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entertainment-no one is moving the ship forward.

My ship felt as if it were spinning, and it was. Not only due to me frequently leaving my seat as captain, but due to interfering with my crew's ability to shine in their roles as well.

So what did I change? If those were my targets to decrease, what needed to increase? I needed to have tangible practices that would not only help me, but enhance the wellbeing of my business, and fast. Here is what I came up with and I hope some of them will be helpful to you: Practice Owner Behaviors to Enhance A Business: Lead From a Grounded Presence. Your energy impacts those around you and will contribute to growth or stuckness. When you feel yourself leading from a place of urgency and reactivity, tend to that sensation before “doing” anything else.

Be Transparent. A tough one. Not only because vulnerability doesn’t feel awesome, but because there is a line of what you share with your team and how you share it. Before sharing information, ensure that you know the function of sharing it. Sharing without intention can threaten a sense of security among your team.

Sit Back. Once you provide space for your team to step up and shine, sit back and trust that they have the skills needed to complete their part of the mission. Trust they will let you know if they need help. Don’t interfere with their zone of genius.

Maintain A Fallible Mindset. There’s a premise in DBT that therapists are human, and therefore we all screw up and do the exact thing we ask our clients to stop doing. This is no different as a practice owner. When you cling to perfection, you will constantly be disappointed and suffocate any shot your practice has to thrive. If you expect mistakes to happen, it won’t be as destabilizing when they do.

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Leaving that meeting, I put effort into tangibly practicing each of these behaviors, and took accountability to decrease the behaviors that I knew were good for no one. As we wrap up Q1 in 2024, I notice a big shift in myself and my business as a result. The funny thing is, since all of the business interfering behaviors were mine, most of the “fixing” and planning that happened was to step back and allow my team to shine. I also noticed that when the skillful behaviors came together, there was a greater sense of connection between myself and my team. As a result of the changes, I found myself spending more time in the office and finding ways to support them in their efforts. My staff have given me feedback about my role recently and have said that they feel not only heard and valued, but that they want to be “in it” with me.

As much as it sucks to have “learned the hard way”, I'm grateful that it pushed me to be open and accept help with moving the ship forward . I didn’t choose a goal to work on that quarter, and by sharing more about my fears and the stakes, my leadership team pushed me out of their way so they could get to it.

What behaviors do you have that threaten or add to the success of your business? What does it look like when you are in the captain’s chair, and what takes you out? I encourage you to start with the lists above and to add to them. Put them in somewhere you will see them and check in with yourself regularly. Though my practice is stabilizing from the storms of rapid growth and change in earlier years, I recognize that the waters are much calmer. As I return to my seat as captain, I lean on these practices to keep me focused on where we are headed, and that is better for everyone on board.

Lead With Humility. My word for 2024. Be ok with not knowing it all. When I take the pressure off of myself to have the answers for everything, things flow much smoother. I feel Kendrick Lamar said it best…”Bitch, be humble. Sit down”. Aye-aye captain!

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HEALTHCARE HIJACK: Navigating the Murky Waters of Insurance-Owned Mental Health Practices MAUREEN WERRBACH

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Building upon the article I wrote in our last issue of The Visionary on The Future of Mental Healthcare, I wanted to highlight a fact I discussedintercompany eliminations. The increasing trend of insurance companies acquiring mental health group practices raises significant concerns and implications for the healthcare industry, particularly regarding intercompany eliminations. This practice involves insurance companies owning their own healthcare providers, including mental health group practices, which they can use to manage how healthcare dollars are spent, potentially circumventing the Affordable Care Act's (ACA) requirement that at least 80% of premium healthcare dollars be spent on member healthcare.

Impact on the General Public For the general public, this trend could have mixed implications. On one hand, insurance companies argue that owning healthcare providers helps streamline services and reduce costs. This could theoretically lead to improved care coordination and potentially lower premiums or out-of-pocket costs for patients. However, there are concerns that this could also lead to reduced choices for patients, as insurance-owned practices might prioritize cost over quality, potentially influencing the type of care patients receive based on financial considerations rather than medical necessity. 100% a concern of mine as a consumer and provider.

Legal and Regulatory Implications Legally, this trend tests the boundaries of the ACA's Medical Loss Ratio (MLR) provision, which was designed to ensure that a majority of premium dollars are spent on patient care rather than administrative costs and profits. By acquiring healthcare providers, insurance companies can arguably shift more expenses into the "patient care" category, even if the money stays within the company. This could make it more challenging for regulators to ensure that funds are being used in a way that directly benefits patients, as intended by the law.

Effects on Small Mental Health Group Practices Small, independent mental health practices could find it increasingly difficult to compete with insurance-owned groups, which can leverage their size and financial resources to negotiate better www.thegrouppraticeexchange.com

payment rates, invest in technology, and offer a broader range of services. This could lead to further consolidation in the healthcare industry, reducing diversity and competition, which are essential for innovation and quality improvement. Smaller practices might be forced to sell to larger entities or close, limiting patients' access to diverse care options.

Forecasting the Future Looking ahead, the trend of insurance companies acquiring mental health and other healthcare practices is likely to continue, driven by the financial incentives and the potential for increased control over healthcare delivery. This could lead to further consolidation in the healthcare industry, with significant implications for access to care, quality of care, and the cost of healthcare services.

However, this trend could also prompt a push for stricter regulations and oversight to ensure that the spirit of the ACA's MLR provision is upheld.

Policymakers might introduce new laws or regulations aimed at preserving competition in the healthcare market and protecting patients' rights to high-quality care. Additionally, there could be a greater emphasis on transparency, requiring insurance-owned practices to disclose more information about how they allocate resources and make care decisions.

Conclusion The implications of insurance companies acquiring mental health group practices are complex and multifaceted, affecting everything from patient care to legal regulations. While there are potential benefits in terms of efficiency and cost-control, there are also significant risks related to quality of care, access, and market competition. As this trend unfolds, it will be crucial for stakeholders across the healthcare industry to closely monitor its impacts and advocate for policies that protect patients' interests and promote a healthy, competitive market for healthcare services.

References: https://wendellpotter.substack.com/p/unitedhealthgroup-takes-wall-street https://www.axios.com/2021/07/16/unitedhealth-optumproviders-intercompany-eliminations https://www.wsj.com/health/healthcare/u-s-launchesantitrust-investigation-of-healthcare-giant-unitedhealthff5a00d2

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Navigating the Aftermath: The Change Healthcare Cyberattack Maureen Werrbach

In February of this year, the healthcare sector was shaken to its core by a cyberattack on Change Healthcare, a crucial player in the healthcare billing and claims management landscape. Owned by Optum, a subsidiary of UnitedHealth Group, Change Healthcare is pivotal in processing patient payments across healthcare organizations. The cyberattack, attributed to the ransomware group BlackCat, led to significant disruptions in healthcare operations nationwide to this day. This incident led to widespread system outages affecting healthcare operations across the US, including payors, private practices, pharmacies, and other healthcare providers. The outage interrupted numerous administrative and billing processes​ (CMADocs)​.

Most impactful for our industry was the disruption of electronic claims processing​.

In this article, I’ll discuss the intricacies of the cyberattack, its impacts on healthcare claim payments, the specific challenges faced by mental health providers and group practices, and how we can better prepare ourselves for potential future IT attacks. *This topic is currently still impacting the healthcare industry, so information is still changing each day. Be sure to check current news for the most up to date information.

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The Change Healthcare Cyberattack and Its Impact on Healthcare On February 21, 2024, Change Healthcare reported an unauthorized access to some of its IT systems.

The company immediately isolated the impacted systems but the damage had been done. BlackCat's attack not only disrupted the billing and claims processes but also extracted six terabytes of data, including sensitive patient information​ (MedCity News)​.

This attack underscored the vulnerability of healthcare IT infrastructure, prompting immediate responses from federal agencies. The Department of Health and Human Services (HHS) coordinated closely with UnitedHealth Group, enforcing measures to ensure continuity of operations for all healthcare providers impacted​ (HHS.gov)​. Despite these efforts, the aftermath of the cyberattack left providers nationwide scrambling, with patients struggling to obtain prescriptions, healthcare providers facing significant administrative bottlenecks and lack of claims payments, and as we are currently witnessing, the closing of group practice doors as practice owners struggle to make payroll.

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Current State of Healthcare Claim Payments for Providers

Impact on Mental Health Providers and Group Practices

In the wake of the attack, the Centers for Medicare & Medicaid Services (CMS) and HHS have introduced several measures to assist providers.

These include expediting new electronic data interchange (EDI) enrollments for Medicare providers needing to switch clearinghouses and urging Medicare Advantage and Part D sponsors to relax prior authorization requirements​ (HHS.gov)​.

EHRs who previously relied on Change Healthcare as their clearinghouse are currently scrambling to accept additional clearinghouses in order to allow providers to submit claims. Optum also initiated a temporary funding assistance program to mitigate short-term cash flow issues for providers affected by the payment disruptions​ (MedCity News), though almost every group practice owner who has communicated that they applied for funding through Optum were given an absurd amount that didn’t nearly cover even one payroll cycle. Early in March, American Hospital Association sent letters to Congress, stating that Optum’s temporary funding assistance program “will not come close to meeting the needs” of providers affected by the attack.

This cyberattack has had a profound impact on group practices. Group practices that accept insurance often operate with tighter margins and are heavily reliant on timely insurance claim reimbursements to sustain operations and payroll.

The disruption in billing and payment processes has exacerbated existing challenges in mental health service delivery, especially for payroll for salaried and hourly practices, and timely pay laws for commission pay practices.

Healthcare providers continue to face hurdles in navigating the disrupted payment landscape, with workarounds often proving time-consuming, expensive, and inefficient​ (MedCity News)​, with still no clear end in sight. At the time of writing this article, lawsuits are beginning to pile up from providers against Change Healthcare in hopes to raise awareness of the incident and it’s continued impact on providers, put pressure on them to fix things quickly, and bring about accountability and transparency of their actions.

14 Billion

Change Healthcare says it has $14 billion in backlogged payments due to the hack since February 21.

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Although specific data on the impact on mental health providers and group practices is still emerging, anecdotal evidence suggests significant operational and financial strain. The administrative overhead required to manage workarounds for billing and claims processing has diverted resources from patient care, compounding the already critical shortage of mental health services. In my own group practice, our administrative team has been working tirelessly learning new platforms for submitting claims, manually submitting claims through Availity for upwards of 50 full time clinicians, and ensuring our EHR patient billing files are still accurate now that we are using an additional platform. In short, it’s a mess for group practices accepting insurance with EHRs who’s clearinghouses go through Change Healthcare. At the time of writing this article, EHRs have been working tirelessly to add clearinghouses to their platforms outside of Change Healthcare in order to be able to submit claims and receive payments.

The cyberattack on Change Healthcare serves as a stark reminder of the fragility of the healthcare sector's IT infrastructure and the critical need for enhanced cybersecurity measures. Looking forward, it's clear that mental health billing, along with the broader healthcare billing landscape, needs to evolve to mitigate the risk of future cyberattacks.

The incident also highlights the necessity for practices to build in contingency plans. It also underscores the importance of transparency and communication between healthcare entities, IT service providers, and government agencies.

Building a collaborative environment where information on threats and vulnerabilities is freely shared can significantly enhance the collective ability to respond to and recover from cyber incidents.

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Strategies for Preparedness in the Event of Future Cyber Attacks To maintain operational resilience and ensure the continuity of claims processing and payments in the event of a cyber breach similar to what happened with Change Healthcare, group practices should look into ways to position themselves better, should a future cyber-attack happen. Below, I’ve outlined 10 ways that may help your practice stay ahead and be better prepared in the event that a similar IT hack or breakdown occurs: Diversify Payment and Claims Processing Vendors: Avoid over-reliance on a single vendor for critical functions such as claims processing and payments. This is the issue that those of us who use an EHR that only relies on Change Healthcare for their clearinghouse have dealt with. Having relationships with multiple vendors can provide alternative pathways should one system become compromised. Advocating for multiple clearinghouses in your EHR is one strategy. Learning an additional platform like Availity is another, albeit less helpful, option.

Implement a Robust Business Continuity Plan: This plan should specifically address cyber incidents and outline the steps to maintain or quickly resume critical operations. The plan could include manual processing protocols, alternative communication channels with payors, and steps to switch to backup systems or vendors​(BCG Global)​.

Establish Manual Workarounds: While less efficient, having a manual process in place for submitting claims and processing payments can be a vital backup. Ensure staff are trained on these procedures and can implement them if electronic systems are down. Create a manual that lists out the steps for submitting and processing claims manually so your administrative team can jump right into it in the event of another IT hiccup.

Maintain Regular Data Backups: Regularly back up critical data, including patient information and billing records, in a secure and separate location. This ensures that you can restore vital information and resume operations more quickly after a cyber incident. This was something I learned during the Change Healthcare cyber-attack. Luckily, patient demographic information was still available to us, but the breach made me think what happens if my EHR was ever compromised. Where can we easily access patient data? Any tech platform we use in our practices can have an IT event that leaves us without the data and information we have within that platform. Don’t assume you will always have access to your information in those platforms and plan accordingly.

Use Encrypted Communication Channels: For sending sensitive information, especially in times of a cyber incident, utilize secure, encrypted communication channels to prevent data breaches during the transmission of claims and payment information. We should already be doing this, but now is the time to think about how our teams communicate sensitive information. Are they trained appropriately on when and how to use the encrypted channels we have?

Cyber Insurance: Consider investing in cyber insurance that covers losses from cyber incidents, including business interruption costs. This can provide financial stability and support recovery efforts if operations are impacted.

Stay Informed on Regulatory Flexibilities: In the wake of the Change Healthcare cyberattack, regulatory bodies like CMS introduced flexibilities for healthcare providers. Staying informed about these changes can help you take advantage of any temporary measures designed to ease the burden on affected providers​ (BCG Global)​.

Build a Resilient IT Infrastructure: Invest in cybersecurity measures that protect against threats and ensure your systems can be isolated and restored quickly in case of an attack. This includes deploying firewalls, antivirus software, intrusion detection systems, and regularly updating all systems to patch vulnerabilities.

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Regular Cybersecurity Training: Educate your staff on the latest cybersecurity threats and best practices.

Regular training can help prevent successful phishing attempts and other common attack vectors that could lead to a breach.

Legal and Financial Preparedness: Work with legal counsel to understand your obligations under HIPAA and other relevant regulations in the event of a data breach. Financially, setting aside reserves or having access to emergency funding can help navigate the period of disruption.

BONUS: Get a business Line of Credit from your bank. In the event that claims payments stop coming in, like in the current situation, having a business line of credit in place can help cover operational and payroll costs.

While the cyberattack on Change Healthcare has presented significant challenges, it also offers an opportunity to rethink and reinforce the security of all technology related things. As we recover and adapt to the realities of this incident, the lessons learned will undoubtedly shape the future of healthcare IT, making it more resilient in the face of evolving cyber threats. The path forward requires us as business leaders to have backup plans and not rely so heavily on technology to perform perfectly. We’ve been put through the ringer since 2020, group practice owners. From Covid-19 nearly shutting our businesses down to the current cyberattack and everything that has affected the mental health world in between, each of these events teaches us a lesson in resiliency and preparedness. And, as visionary leaders, pivoting and action planning is in our wheelhouse. So, what action will you take to better support your business in the event of a future issue?

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PSYCHEDELIC THERAPY TRENDS & PATHWAYS By: Christopher Brown, LICSW

As visionary therapists, it’s important we stay informed about emerging trends in the mental health space. Psychedelics are one of the most exciting and promising trends capturing the attention of mental health researchers, practitioners, and clients alike. In this article, you’ll gain a deeper understanding of these trends as well as actionable insights you can use to begin to consider how this can inform the future of your practice.

Positive mental health implications of psychedelics continue to be validated through research at respected institutions like Johns Hopkins 1, Massachusetts General Hospital 2, Harvard 3, Stanford 4, and more 5. Even federal agencies like the Veterans Affairs 6 and the Department of Defense are building out research programs, with DoD research being funded by a first-ever provision in a recent defense bill passed in Washington D.C 7.

Every week it seems there’s a new headline with psychedelic research 8 demonstrating promising mental health outcomes and bringing us closer to greater accessibility. Just in February, Lykos Therapeutics (formerly the MAPS Public Benefit Corporation) announced the FDA granted their application Priority Review 9 and is expected to announce its determination in August 2024, which would lead to a recommendation for the DEA to reclassify MDMA as a controlled substance. This comes after nearly two decades of MAPS led research on MDMA-assisted therapy for PTSD, demonstrating over 65% of participants no longer met criteria for PTSD 10 at the completion of the MAPS 15 session protocol, which includes 2-3 sessions of MDMA administration.

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Meanwhile, the mental health crisis in the US continues, with US surgeons general sharing strong warnings about the impacts to society and encouraging greater efforts in mental health care 11.

As innovative therapists, it’s important we pay attention to these evolving trends in our field, because whether or not we choose to pay attention, our clients sure are.

A 2022 study 12 found 65% of Americans suffering from mental health conditions wanted access to psychedelics. Compare that with a 2021 study 13 which found only 19.5% of psychologists surveyed felt they had a clear understanding of psychedelic assisted treatment. While I hope this number has improved since 2021, I call this the Client-Therapist Gap and I know it hasn’t disappeared.

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Before I continue let me add a strong notable third reason: Therapists living in or near states that are decriminalizing psychedelics for therapeutic purposes.

Naturally more clients in or near these states are asking about how they might include psychedelic therapies in supporting their therapeutic goals.

A developing question is how to fit psychedelic therapies into the existing mental health paradigm.

Currently the most commonly used framework, what’s been used in most research studying psychedelic compounds, is psychedelic-assisted therapy (PAT). PAT is a 3-stage protocol including preparation sessions (before the drug), experiential sessions (with the drug), and integration sessions (after the drug). Rightly so, this approach requires extensive training to mitigate risk and follow ethical and clinical best practices when supporting clients in altered states of consciousness (experiential stage). It’s also only legally feasible for therapists supporting FDA approved research studies or in states where legalization efforts have taken place.

PAT may not be for everyone. In fact for me as an EMDR therapist, I don’t believe I will ever need to be involved in the experiential (with the drug) stage of PAT with a client (although I’ve completed the 100 hour MAPS MDMA-Assisted Therapist training and appreciate the excitement for it). However, I do see immense value in supporting clients in the preparation (before) and integration (after) phases, leveraging therapeutic psychedelic experiences they pursue independently toward their treatment goals with me. One of the outcomes (among many) I’m most excited about with psychedelics is their ability to promote neuroplasticity 13 in the weeks to months after, which can be immensely valuable to leverage during the course of therapy to strengthen outcomes, but I digress (I’ll save my excitement there for a future article).

I consult with private practice therapists exploring how to incorporate psychedelic therapies in their practice and I’ve noticed two primary reasons why they decide to learn more: 1) they read the research and cannot ignore the promising outcomes presented, or 2) they’ve had clients ask about psychedelics as a treatment option, or who’ve shared about incredible healing experiences they had on a plant medicine retreat. One of these is usually all it takes for a therapist to begin taking this trend more seriously.

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The approach to support clients independently seeking psychedelic therapy without the therapist being involved in the experiential stage with the drug, is known as psychedelic harm reduction and integration therapy (PHRI). I believe within the next 10 years all therapists will require competency in PHRI in the same way all therapists need to have competency in suicide risk assessments. If the current pace continues, psychedelic therapy options will become so commonplace that therapists who don’t know how to incorporate it into a treatment approach will be perceived as unethical or incompetent.

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“A 2022 study 12 found 65% of Americans suffering from mental health conditions wanted access to psychedelics.”

Harm reduction (the HR of PHRI) is a term borrowed from the substance abuse field, which holds that therapists can ethically reduce harm to clients by having therapeutic discussions around drug use and exploring ways to mitigate harm to the client. It should be noted that psychedelic substances in controlled therapeutic settings show very low risk for adverse effects 14. However since there are important medical and psychiatric contraindications with psychedelics, and the additional problem of illicit sources existing in the world, harm reduction conversations are essential if a therapist learns a client intends to pursue psychedelic therapies independently.

Knowing we cannot do anything to stop individuals from pursuing their own psychedelic experiences, therapists must be able to help clients understand researchinformed risks and benefits, as well as ethical safety and legality considerations. Having a PHRI mindset is going to be a growing requirement for the mental health profession, regardless of whether clinicians are interested in becoming a PAT provider.

Graphic from my private practice website comparing my PHRI approach to the PAT model.

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Indeed, PHRI is already relevant and its need is growing every day. Especially if you operate in a state, or adjacent to a state, where psychedelic therapies have been decriminalized (a trend expected to continue on a similar trajectory as what happened with decriminalizing cannabis). If you see clients in or near one of these states 15, I would be surprised if you haven’t had the question of psychedelic therapies come up in a session already. It’s not a matter of if, but when.

hope you’ve discovered some pathways you can explore to integrate this insight into your practice and the larger mental health space. By choosing to not ignore this trend and instead follow the innovation (or perhaps more accurately, support the Western return to ancient practices of using plant medicines for wellbeing 16), you will be ahead of your peers and your practice will remain competitive in this evolving landscape.

References

If you’re convinced by now, you might be wondering where to start. As I was preparing to add a PHRI approach to my practice I first dove deep into the ethical and legal considerations, which led me to write a 20+ page ethical due diligence paper just to help me wrap my head around this topic. What still sticks out to me the most is this: for therapists practicing on the edge of their scope of practice (read therapists using innovative, novel approaches), consultation and training are essential.

In my consultation group with therapists we explore legal considerations, ethics in marketing, clinical considerations, case studies, questions to ask before choosing a training, how to incorporate a PHRI approach in a treatment plan, collaborative care efforts, etc. These topics are good places to start when searching for consultation and training opportunities. It also matters whether you feel more drawn to a PAT or PHRI approach.

With PAT, you may need considerably more training than with PHRI due to the complexity of working with clients in an altered state of consciousness that PAT requires. With PHRI, you may need shorter training sessions that fill in competencies you aren’t yet familiar with (i.e. risks/benefits of a specific drug, harm reduction strategies, approaches to integration, etc.).

There are many training and consultation options available, but unfortunately just as many with high cost and accessibility barriers. Fortunately, a few hours of online research will lead you to a wealth of free or lowcost resources. If this is new to you, start with self-led research. As you become more familiar with these topics you’ll start to get a clearer picture of your competency gaps and what sort of training you need.

And consider consultation along the way.

1. https://hopkinspsychedelic.org 2. https://www.massgeneral.org/psychiatry/treatments -and-services/center-for-the-neuroscience-ofpsychedelics 3. https://news.harvard.edu/gazette/story/2021/06/har vard-medical-school-professor-discusses-future-ofpsychedelics/ 4. https://med.stanford.edu/spsg/research.html 5. https://maps.org/news/bulletin/expandingacademic-consciousness-more-universities-stepinto-psychedelic-research/ 6. https://news.va.gov/press-room/to-improve-carefor-veterans-va-to-fund-studies-on-new-therapiesfor-treating-mental-health-conditions/ 7. https://www.militarytimes.com/newsletters/2023/12/ 15/first-ever-provision-for-psychedelic-studiesincluded-in-defense-bill/ 8. https://psychedelicalpha.com/news/psychedelicresearch-bulletin-january-2024 9. https://maps.org/2024/02/09/maps-congratulateslykos-on-acceptance-of-new-drug-application/ 10. https://maps.org/mdma/ptsd/mapp1/ 11. https://www.cnn.com/2023/09/28/health/mentalhealth-crisis-undermine-our-democracy-ussurgeon-generals-say/index.html 12. https://www.forbes.com/sites/lindseybartlett/2022/0 1/18/study-finds-65-of-americans-with-mentalhealth-conditions-want-access-to-psychedelics/ 13. https://www.tandfonline.com/doi/full/10.1080/02791 072.2021.1971343 14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC890 5125/ 15. https://psychedelicalpha.com/data/psychedeliclaws 16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC841 2860/

I hope this look into the trends in psychedelic research and therapy has provided you some clarity. More so, I

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