LEADING THE WAY IN GROUP PRACTICE INNOVATION
HEALTH: TRENDS AND FUTURE DIRECTION
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IS YOUR GROUP PRACTICE PREPARED FOR THE FUTURE? RACIALLY RESPONSIVE LEADERSHIP WORKPLACE MENTAL
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THE POWER OF CLINICAL SUPERVISION AND LEADERSHIP
EDITOR
MAUREEN WERRBACH
MAUREEN WERRBACH
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Dear Readers,
Welcome to the third issue of Visionary Magazine, where we continue our commitment to leading with foresight and innovation in the mental health field. In this edition, we delve deep into what it means to be a visionary leader during times of profound change. The pace at which our industry evolves demands not only resilience but also a proactive stance in preparing for what lies ahead
In our featured articles, we explore essential strategies for building resilience, ensuring that your practice is not just surviving but thriving in an ever-changing landscape We recognize that resilience is not just about bouncing back but also forging ahead with strength and adaptability. This issue provides you with insights and tools to navigate these shifts effectively, keeping your practice at the forefront of innovation.
Preparation for the future is another cornerstone of visionary leadership. It's about understanding the trends, anticipating challenges, and implementing solutions before they become necessary. Our contributors share their expertise on how to equip your practice with the necessary resources and foresight to stay ahead of the curve
A crucial part of this preparation involves building a positive workplace community This issue takes a closer look at innovative hiring practices that not only fill roles but enrich your team's dynamic We discuss the importance of prioritizing employee mental health, fostering an environment of racial responsiveness, and enhancing clinical supervision. Each of these elements contributes to a supportive and inclusive workplace culture, which is vital for sustaining long-term success.
Being a visionary leader means more than overseeing a practice; it involves inspiring change, advocating for mental wellness, and setting a standard for ethical and compassionate care Our aim with this issue is to provide you with the knowledge and inspiration to lead with vision, ensuring a prosperous and impactful future for your practice
Thank you for joining us on this journey of growth and leadership. Let us continue to push boundaries, inspire change, and lead with purpose.
With gratitude,
Maureen Werrbach, LCPC
Editor-in-Chief, The Visionary
BY MAUREEN WERRBACH
In an ever-changing world, mental health practices must be prepared to face disruptions. Whether from global pandemics, economic downturns, or technological advancements, the ability to adapt is crucial for longterm success. Building a resilient practice requires foresight, strategic planning, and a proactive mindset. As I connect with group practices throughout the years, disruptions like the 2008 housing crash, the COVID-19 pandemic shutdown, the subsequent employee turnover and shortage, and most currently, the therapist supply/demand issue that’s led to a national decrease in client inquiries, I can’t help but notice how often group practice owners step into a state of freeze. The antidote is to forecast and prepare for disruptions, so it minimally impacts your business. It means pivoting and adjusting, whether by diversifying services, shifting payors and streams of income, or by means (within your values and vision) that align with the future of our industry
tBecause it is an inevitable part of the landscape of entrepreneurship, let’s take a look at how you can prepare for future disruptions.
Technological advancements are reshaping the mental health industry Telehealth, online programs, EHRs, and AI are just a few examples of how technology can enhance practice operations To build resilience, mental health practices should:
Utilize Online Tech Available to You: There are so many technologies available to group practices, from financial support, organizational support, time management, HR, client assessments, and client inquiry journeys. Research and utilize the tech available to you to minimize human error and
disruptions. What process in your practice could use tech support?
Leverage AI and Data Analytics: AI can assist in predictive analysis, patient triage, and personalized treatment plans Data analytics can provide insights into patient trends, helping practices make informed decisions and anticipate future needs What data are you unaware of in your practice?
Relying on a single revenue source can leave a practice vulnerable to disruptions. Diversifying income streams can create financial stability, reduce staff burnout, diversify employee work, and reduce risk Consider the following approaches:
Expand Service Offerings: Diversify the types of services you provide. In addition to traditional therapy, consider offering group sessions, workshops, and wellness programs. Holistic services that support the “whole person ” is increasing in popularity, as a result of the pandemic and overall burnout People are looking to have their body, mind, and spirit needs met in one place
Develop Online Programs: Create online courses, webinars, and digital resources. These can be valuable additions to your practice and generate passive income. Online programs can also reach a wider audience beyond your local community, and allow you to offer support to those who need additional touchpoints before reaching out for therapy
Corporate Wellness Services: Partner with businesses and community organizations to offer mental health services to their employees. These collaborations can open new revenue channels and enhance your practice's visibility and reputation It also allows your team to diversify their workload and expands where your business receives income (thereby not relying on a single source for income).
Effective financial management is crucial for building a resilient practice. By maintaining a healthy financial foundation, you can better withstand disruptions. Think about the financial shock that the pandemic initially created Or the Change Healthcare cyber-attack Many group practices closed their doors because they didn’t have the financial strength to withstand the disruption Key strategies include:
Create a Financial Cushion: Establish an emergency fund to cover unexpected expenses. Aim to save at least three to six months' worth of operating costs. This financial buffer can provide stability during challenging times.
Optimize Billing and Collections: Ensure that your billing processes are efficient and transparent Regularly review your accounts receivable to identify and address any outstanding payments.
Budget Wisely: Develop a detailed budget that outlines your practice's income and expenses. Regularly review and adjust your budget to reflect changing circumstances. Prioritize spending on essential areas while minimizing unnecessary expenses Profit First helped me organize my group practice’s flow of income and expenses
Foster a Strong Organizational Community
A resilient practice is built on a foundation of strong organizational community. Cultivating a positive work environment can enhance staff morale, retention, and overall practice stability. Here are some ways to focus on creating community in your workplace:
Support Professional Development: Invest in the ongoing education and training of your staff Encourage them to attend conferences, workshops, and courses to stay updated on their specialty. Better yet, apply to be an ACEP provider so you can offer internal CEs as a benefit of employment. Additionally, creating growth opportunities for employees, like leadership possibilities or spearheading initiatives, will provide the right employees to grow in (or out of) their roles
Promote Accommodations and Flexibility: Ensure that your practice offers flexibility. Implement
flexible working hours, remote work options, or accommodations to support the best working environments for your team. A supportive work environment can reduce burnout and improve productivity.
Encourage Open Communication: Foster a culture of transparency and open communication Regularly check in with your staff to understand their concerns and suggestions. Address issues promptly and collaboratively to maintain a healthy workplace.
Identifying and mitigating risks is essential for building a practice that can withstand disruptions Implementing risk management strategies can help you anticipate and address potential interruptions. Consider the following steps:
Conduct a Risk Assessment: Identify potential risks that could impact your practice. These may include issues within leases, cyberattacks, regulatory changes, technology disruptions, turnover, or economic downturns Assess the likelihood and impact of each risk to prioritize your mitigation efforts.
Develop a Contingency Plan: Create a comprehensive contingency plan that outlines how your practice will respond to different types of disruptions. Include protocols for maintaining operations, communicating with clients, and safeguarding data Regularly review and update your plan to ensure its relevance
Building strong relationships with your clients is crucial for long-term resilience. Loyal clients are more likely to stay with your practice during disruptions and refer others to your services Focus on ways to improve client relationships in your group practice For example:
Prioritize Client Satisfaction: Deliver high-quality care and exceptional client service. Regularly seek feedback from clients to understand their needs and improve your services. Address any concerns promptly and empathetically. What is your schedule for giving client satisfaction surveys? Do your therapists regularly assess how sessions are going?
Maintain Regular Communication: Keep clients informed about any changes to your practice, such as new services or temporary closures. Use multiple communication channels, including email, social media, and newsletters, to stay connected with your clients.
Offer Flexible Scheduling: Provide flexible appointment options, including evening and weekend sessions Flexibility can accommodate clients' diverse schedules and enhance their satisfaction with your practice
Building a group practice requires a proactive approach, with vision, resilience, grit, forecasting and decision-making. With careful planning and a forwardthinking mindset, your practice can achieve long-term stability and success.
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Let's face it: you didn't get into mental health for the heaps of praise or for private jet privileges into the Hamptons Would be nice, though! You're likely in this field to help people grow and heal, and usually from pretty serious stuff. I’m sure you might not expect to be a superhero, but doing super work is on your SMART goal list. As you strive to be the best version of yourself professionally, are you tapping into all the opportunities that can superfuel your skills and impact?
Here's the cold, hard truth: too many of us get stuck in a rut We see clients, day in and day out, without sharpening our skills We work in places that feel about as inspiring as a waiting room magazine from 2007. And before we know it, we ' re on autopilot –not keeping up with research, losing our spark, and shortchanging the very people we set out to help.
But hold up! It doesn't have to be that way By investing in clinical supervision and leadership development, you can level up your game and become the kind of practitioner who truly makes an impact in their client’s lives
If clinical supervision were a supplement, it would be flying off the shelves faster than green juice at a yoga retreat. The research is that good.
Regular supervision from an experienced mentor is like steroids for your clinical skills It helps you navigate tricky cases and ethical dilemmas with the ease of a seasoned clinician. In fact, a study by Bucky et al. (2017) found that supervision characteristics, particularly the supervisory working alliance, play a crucial role in the development of doctoral-level supervisees. This means that having a good relationship with your supervisor can significantly boost your professional growth
That kind of support isn’t just for the clinician Skilled clinical supervision actually improves patient outcomes. Rousmaniere et al. (2016) discovered that supervisor variance accounts for a significant portion of client outcome in routine practice. That's right – your clients get better results when you ' re getting supportive guidance. It's like having a personal trainer for your therapeutic skills. And that isn’t just supervision during licensure, but supervision throughout the lifespan of your career!
Therapists who participate in regular supervision are less likely to burn out or get stuck in a rut. They keep their skills sharp and their practices fresh. Watkins et al. (2019) argue that supervision incorporates both common and specific factors that contribute to therapist development, much like the therapeutic relationship in psychotherapy. It's the difference between being a therapist and being a therapist who's on fire (metaphorically, of course – we don't condone actual flames in the office)
Clinical supervision is a leadership role. And taking on leadership roles is like hitting the turbo boost on your professional growth.
Aarons et al (2015) found that mental health organizations with strong clinical leaders consistently deliver better care and outcomes Their study on Leadership and Organizational Change for Implementation (LOCI) showed that leadership development interventions can significantly improve evidence-based practice implementation. Why? Because these leaders:
Keep everyone on their toes with best practices and ethical standards
Make sure the team is always learning
Stay ahead of the curve with new research
Create an environment where people value relationships and seek to promote a positive workplace culture
Align their team around a clear mission, vision, and organizational values
But here's the best part: leadership makes you, the leader, better too
It forces you to up your game, master new skills, and think big picture Duffey et al (2018) explored the concept of developmental relational counseling in supervision, emphasizing how relational-cultural theory can enhance both supervision and leadership skills. This approach encourages growthfostering relationships, which are crucial in both clinical work and organizational leadership.
Plus, leadership opens doors to incredible opportunities like publishing, public speaking and training, academic teaching, or starting new programs, which allow you to have a bigger voice in
So, if all this sounds great, why isn't everyone doing it? Well, humans are creatures of habit. We like our routines. Change is scary. Frederick Douglas said, “if there is no struggle, there is no progress. ”
If you ' re worried about obstacles, let's tackle them:
Money tight? Look for grants or professional development funds Many organizations will pay for training that makes you better at your job And lots of organizations offer clinical supervision training for free. No time? Many programs are flexible and online. You can level up your skills while wearing pajamas (we won't tell).
Scared of taking on too much? Start small Listen to a supervision podcast on your commute like Supervision Simplified (shameless plug) for small ideas that might spark new skills practice Confidence shaky? That's why you need a mentor. They'll help you see how awesome you already are (and how much more awesome you can be).
The biggest hurdle? It's that voice in your head saying, "Eh, I'm good enough " But here's the thing: you didn't get into this field to be "good enough " You got into it to make a difference
Cashwell and Dooley (2019) found that supervision has a significant impact on counselor self-efficacy. Their research shows that as counselors receive more supervision, their confidence in their abilities grows. So not only does supervision make you better at your job, it also makes you feel better about your job Talk about a win-win!
Now, before you rush off to become the next superhero of the mental health world, let's talk about your secret weapon: community. Because even Batman had Alfred (and let's be honest, Alfred was the real MVP).
Here's the thing: developing your leadership skills isn't a solo journey It's not about locking yourself in a room with a stack of leadership books and emerging as the next Tony Robbins (though if that works for you, go for it). Real leadership growth happens when you connect, collaborate, and learn from others.
Think of it like this: if supervision is your personal trainer, your professional community is the gym It's where you get to flex those new skills, spot others, and occasionally drop the weights on your toe and get some empathy from the crowd
Research backs this up. A study by Gentry et al. (2021) found that peer-to-peer learning networks significantly enhanced leadership development in healthcare settings. Participants reported feeling more confident, more connected, and better equipped to tackle leadership challenges A whole squad of cheerleaders waving evidence-based practices
So, how do you tap into this power of community?
1. Join Professional Associations - you know all of the usual suspects + the Clinical Supervision Directory is building community for supervisors every day. Zhang and Fjermestad (2021) found that leaders who actively engaged in professional communities were more innovative, adaptable, and effective in their roles
2 Participate in Peer Supervision Groups: Laird and Hollon (2021) found that peer supervision groups not only improved clinical skills but also fostered leadership qualities like problem-solving and decision-making.
3. Attend Workshops and Conferences: These events are goldmines for networking and learning Where else can you discuss the latest in cognitivebehavioral therapy over cocktails? And anyone that has ever been to an event like this knows the power of connecting.
4. Engage in Online Forums and Social Media: Platforms like LinkedIn or specialized mental health forums can connect you with professionals worldwide. The Exchange, Facebooks groups, and masterminds of any size can be valuable opportunities to build affinity around specialty
areas
5 Collaborate on Research or Projects: Working with others on publications, presentations, or community initiatives can sharpen your leadership skills while making a real impact. Plus there is an added benefit of building your own credibility in the professional community.
Remember, leadership isn't about being the loudest voice in the room It's about inspiring, guiding, and bringing out the best in others And you can't do that in a vacuum You have the chance to be a force for change in this world But you ' ve got to grab it with both hands. Choose growth over comfort. Because the people you serve deserve your absolute best.
Building a community alongside clinicians who want to grow, and who support excellence in the field requires more stamina these days than when I first started my career thirty years ago There is a quote, attributed to several people, that essentially says, “If you don’t have a seat at the table, make your own table.” Sometimes leadership starts at your own table.
Now, go forth and be awesome. Your cape is waiting.
References:
Aarons, G A , Ehrhart, M G , Farahnak, L R , & Hurlburt, M S (2015) Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. Implementation Science, 10(1), 11.
Bucky, S F , Marques, S , Daly, J , Alley, J , & Karp, A (2017) Supervision characteristics related to the supervisory working alliance as rated by doctorallevel supervisees The Clinical Supervisor, 36(1), 130142.
Cashwell, T. H., & Dooley, K. (2019). The impact of supervision on counselor self-efficacy. The Clinical Supervisor, 38(1), 79-96.
Duffey, T , Haberstroh, S , Ciepcielinski, E , & Gonzales, C (2018) Relational-cultural theory and supervision: Evaluating developmental relational counseling. Journal of Counseling & Development, 96(5), 449-460.
Gentry, S., Milden, L., & Kelly, M. P. (2021). Why is working together so difficult? Investigating barriers to collaboration and shared leadership in healthcare Journal of Interprofessional Care, 35(6), 851-860
Laird, K. T., & Hollon, S. D. (2021). Peer supervision in cognitive behavioral therapy: A qualitative study of trainee and supervisor perspectives Cognitive and Behavioral Practice, 28(2), 229-241
Rousmaniere, T G , Swift, J K , Babins-Wagner, R , Whipple, J. L., & Berzins, S. (2016). Supervisor variance in psychotherapy outcome in routine practice. Psychotherapy Research, 26(2), 196-205.
Watkins Jr, C E , Budge, S L , & Callahan, J L (2019) Common and specific factors converging in psychotherapy supervision: A supervisory extrapolation of the Wampold/Budge psychotherapy relationship model. Journal of Psychotherapy Integration, 29(3), 272-284.
Zhang, L , & Fjermestad, J (2021) Collaborative leadership for organizational innovation: A systematic literature review Group Decision and Negotiation, 30(6), 1323-1358.
MaureenWerrbach
In a healthcare landscape characterized by rapid consolidation, evolving payment models, and technological shifts, mental health group practices are at a critical juncture These changes pose unique challenges but also open up new avenues for growth and improved patient care Understanding these dynamics is crucial for mental health professionals aiming to adapt and thrive in this new environment.
The decision by Walmart to close all its health clinics and Walgreens' VillageMD to reduce its operations highlights a broader trend of reevaluation in healthcare strategy These decisions stem from complex challenges including economic pressures, changing regulatory environments, and the high costs of running healthcare services that have proven difficult to sustain. This shift signals a move away from the expansionist strategies these companies previously pursued and underscores the difficulties in maintaining profitability in healthcare, especially in services like mental health which require specialized, ongoing engagement.
The recent trend of insurers and private equity firms joining forces to control more of the healthcare system is unsettling for many in the healthcare sector, particularly those in mental health services. As these larger entities consolidate control, they often prioritize profitability over patient outcomes, which can directly conflict with the ethos of mental health care that emphasizes patient-centered approaches For mental health practices, this means navigating a landscape where funding and strategic partnerships could be necessary to sustain
operations or to scale services effectively without compromising on care quality.
Value-Based Care (VBC) continues to be a significant buzzword in healthcare, lauded for its potential to reduce costs and improve care quality by shifting away from fee-for-service models. However, as Preston Alexander insightfully critiques, the implementation of VBC can be fraught with challenges, especially in mental health where outcomes are harder to measure and the patient journey is often non-linear Mental health group practices need to carefully evaluate how VBC contracts are structured to ensure that they truly benefit the patient while also maintaining the financial viability of the practice. Practices need to develop robust systems for tracking patient outcomes and demonstrating the effectiveness of their care models. This might include investing in advanced data analytics to monitor treatment effectiveness and patient progress over time, ensuring that they can meet the metrics required under VBC agreements
The closure of independent pharmacies, largely driven by the aggressive tactics of Pharmacy Benefit Managers (PBMs), represents another critical area of concern. For mental health practitioners, the accessibility and cost of medications can significantly influence treatment plans and outcomes The consolidation in the pharmacy sector often leads to higher costs and less choice, directly impacting patients who rely on
medications for their mental health conditions. Advocating for more stringent regulations on PBMs and supporting policies that favor transparency and fairness in drug pricing could be vital steps for mental health practices Additionally, these independent pharmacy closures signals what we are seeing happen in the mental health world- the consolidating of group practices and less choices for clients.
Despite the significant retreat from telehealth initiatives by several healthcare behemoths, like Optum, it's crucial not to interpret these moves as the downfall for telehealth Instead, they reflect a market correction after the unprecedented surge during the pandemic. For instance, while Optum is shutting down its Virtual Care, the company emphasizes that virtual care remains a core part of its integrated care strategy, albeit with a more refined focus.
This recalibration could be seen as a response to the explosive, yet unsustainable growth spurt fueled by the pandemic, as well as recent reimbursement decreases for telehealth
Enhanced Specialization and Personalization: Differentiating through specialized services that deeply address specific mental health issues can help practices stand out in a market increasingly dominated by large healthcare entities
Technological Empowerment: Investing in technology to enhance treatment options, patient tracking, and personalized care plans can significantly improve outcomes and patient satisfaction, making the practice more competitive.
Advocacy and Policy Engagement: Active involvement in advocacy for fair healthcare policies and regulations can help shape a more favorable environment for mental health practices and their patients
Building Robust Networks: Developing strong networks with other healthcare providers, community organizations, and advocacy groups can enhance service offerings and create more integrated care pathways for patients.
The landscape for mental health group practices is evolving with significant implications due to the consolidation of healthcare entities, shifts towards value-based care, changes in pharmacy management, and the integration of telehealth By understanding and strategically responding to these changes, mental health practices can not only navigate these challenges but also seize new opportunities to enhance patient care and secure their place in the future of healthcare.
References:
https://www beckershospitalreview com/disruptors /disruptors-are-retreating-from-healthcare.html
https://www.beckershospitalreview.com/disruptors /optum-shutting-down-telehealth-business.html? utm medium=email&utm content=newsletter&fbcli d=IwZXh0bgNhZW0CMTAAAR3w cd6WPf55lWpN oev2yBCXlD0ckA4jnuinzcPkw-etq3TwYHXoPYmQ aem 9EYNscNtZraEiEmMTYpL2A
https://substack com/home/post/p-145301273? source=queue
https://www.thehealthcarebreakdown.com/p/thehealthcare-breakdown-no-042-breaking? r=2vz0li&utm medium=ios&fbclid=IwZXh0bgNhZW0 CMTEAAR0Uy9VBlRJ9Cyl4boH1gjPKoVMtOjxcoTCIEArQrDpAKQ6fNfS8XC2gvs aem 3WOK 7cZopqhZeJ5TeeiQ&triedRedirect=true
https://substack com/home/post/p-145798815? source=queue
All group practices delegate as they grow their business. Are you delegating enough? Take a look at the common roles and tasks that are delegated at each stage of practice ownership.
Billing (usually outsourced)
Phones (usually outsourced)
Payroll
Accounting
Minimal support based on time spent + affordability(usually outsourced and PT)
Clinical Lead
Admin Lead
Admin Assistant
Social Media Manager
Digital Ads Manager
Support tends to come in house, more FT support. Support tends to focus on minimal coverage in all areas.
Leadership Team
Admin Team
Additional Supports
At this point,individual support gets replaced by teams. Focus is on creating a team that can replace the owner.
HR Ops Lead
Payroll Manager
Legal Team
CFO
Administrative Ops Lead
Billing Manager
Client Care Coordinator
Benefits Coordinator
Clinical Ops Lead
Supervisors
Recruiting and Onboarding Lead
DEI Lead
BY MAUREEN WERRBACH
In recent years, the importance of mental health support in the workplace has gained significant recognition With increasing awareness of mental health issues and their impact on employee well-being (and as a result, productivity and morale), organizations are prioritizing mental health initiatives like never before. As we move forward as both advocates for mental well-being and mental health business owners, it's essential to understand the evolving landscape of workplace mental health support and forecast emerging trends and that can not only support our employees, but also become a service we can offer to businesses. One that focus on proactively supporting employees’ mental health before they seek treatment.
The shift towards prioritizing mental health in the workplace has been driven by several factors. The COVID-19 pandemic underscored
the importance of mental health, with most employees experiencing heightened levels of stress, anxiety, and depression coupled with increased expectations, high staff turnover, and burnout. Companies have responded by implementing mental health programs (and removing them or forgetting about them), offering remote work options (and then restricting it), and attempting to shift the culture of their workplaces, with no real luck Not only has there be no real progress on improving employee mental health, current trends show a decline. Currently, there is a major gap in support to companies in prioritizing mental health and wellness in the workplace. With high turnover, low morale, and increased pressure from leadership to do more, create more, produce more, mental health group practices are in a unique position to offer support to business owners, leaders, and employees Therapists can step into organizations and offer a range of services to organizations who are needing
support, from EAP services, to leadership education, to employee advocacy
When thinking through a Visionary lens, forecasting and pivoting are a constant. As we see trends in reimbursement dips, economic downturn, and referral slowdowns, looking at how you can diversify your services becomes pivotal in maintaining business footing Corporate workplace wellbeing is one such service that is showing no near slowdown, and the field is wide open for you to make your unique mark. Let’s see some of the ways mental health practices can support employee well-being.
Organizations are moving beyond traditional mental health support to adopt a more holistic approach to employee well-being This involves integrating mental, physical, and emotional health initiatives into comprehensive wellness programs. Companies are offering resources such as fitness classes, mindfulness sessions, and nutrition counseling, recognizing that overall well-being is interconnected Group practices that who’s values align with holistic, more integrated wellness support will do well in the future, as they can more wholly support companies’ employees.
Leaders play a crucial role in supporting their teams' mental health. Because of this, there is an increasing focus on equipping managers and leaders with the skills and knowledge to identify and address mental health issues
Training programs developed to help managers recognize signs of distress, engage in
empathetic conversations, and provide appropriate support are increasingly becoming more sought out by companies looking to retain employees Group practices can provide this support through bespoke packages aimed at equipping leaders with the skills to effectively support and center mental health in the workplace, thereby increasing morale and retention.
Prevention is becoming a key component of workplace mental health initiatives
Organizations are proactively addressing mental health by implementing strategies aimed at preventing issues before they escalate. This includes promoting work-life balance, reducing workplace stressors, and fostering a positive organizational culture. Group practices can use their skills and resources to provide preventative support to employees in organizations through customized care plans Think business overall wellbeing assessments, affinity groups, personalized support, retreats, trainings, consultation, and facilitated group coaching. Or as we call it in my group practice corporate program, the CWO (Chief Wellness Officer) role in organizations.
Mental health is an integral part of DEI efforts. Companies are increasingly recognizing the intersectionality between mental health and various aspects of identity, such as race, gender, and sexual orientation. By integrating mental health support into DEI initiatives, organizations can create a more inclusive and supportive environment for all employees
Group practices can lend their skills in supporting collective liberation by supporting employees and leaders of organizations in prioritizing how identity impacts work, relationships, and dynamics, and support consistent reflection and review of policies, procedures, and dynamics that may impact employee safety.
As we look to the future, several key directions are likely to shape the evolution of workplace mental health support. As you read on, think of how your group practice could support the future directions of mental well-being in the workplace.
The use of data analytics to understand and address mental health trends within the workplace is expected to grow Employers will leverage data to identify patterns, measure the effectiveness of mental health programs, and make informed decisions about resource allocation. Data-driven approaches will enable more targeted and impactful interventions.
Organizations will increasingly track mental health metrics alongside traditional performance indicators. By measuring factors such as employee well-being, engagement, and burnout levels, companies can gain a comprehensive understanding of their workforce's mental health and implement timely interventions
Empowering employees to take the lead in mental health initiatives will become more
prevalent. Peer support programs, employee resource groups, and mental health ambassadors can play a significant role in fostering a supportive culture When employees are actively involved in shaping mental health initiatives, it enhances their sense of ownership and engagement
As companies expand their global footprint, there will be a greater emphasis on developing culturally sensitive mental health strategies. Understanding the unique mental health challenges faced by employees in different regions and tailoring support accordingly will be crucial for multinational organizations
To stay ahead of the curve, employers are considering the following practices for supporting workplace mental health Group practices can help companies engage in these practices
Creating an environment where employees feel safe discussing their mental health without fear of stigma or repercussions will become a baseline expectation. Employers that are mental health conscious will encourage open conversations, provide training to reduce stigma, and ensure that mental health support is visible and accessible.
Businesses are beginning to invest in corporate well-being by developing holistic wellness programs that address physical, mental, and emotional health
Ensuring that mental health resources are easily accessible to all employees, regardless of their location or work schedule is imperative. Group practices that leverage digital tools and platforms to offer flexible support options, and regularly communicate the availability of these resources will be highly sought out by corporations
Leaders and managers are becoming equipped with the skills to recognize and address mental health issues within their teams. Group practices that integrate into corporations can provide training on empathetic communication, stress management, and how to connect employees with appropriate support services
Prevention is key One of the beset things we can do is focus on preventative strategies to reduce the risk of mental health issues
Promoting work-life balance, offering flexible work arrangements, and addressing workplace stressors proactively is the key to changing the landscape of employee stress and burnout.
The landscape of workplace mental health is evolving rapidly, driven by increased awareness and a growing commitment to employee well-being As we move forward, the integration of mental health into the core of organizational culture will be essential for fostering a healthy, engaged, and productive workforce, and group practices have the expertise to step in and help the growing movement of corporate well-being
BY: GABRIELLE JULIANO-VILLANI
EBITDA = E + I + T + D + A
EBITDA= Earnings Before Interest, Taxes, Depreciation, and Amortization
It is one of the key profitability measures used to look at your practice’s overall financial health and ability to generate cash. This is one of the factors that may be used to get a valuation of your business (aka figure out how much it’s worth!). Typically, if you have a revenue of less than $1M you may be able to get 4-5x your EBITDA in a sale, and over $1M in revenue you could get up to 10x your EBITDA. There are multiple ways to calculate your business’ value and this formula does not guarantee anything. I recommend meeting with your accountant and/or a broker to get a valuation of your business completed…but here’s how to figure out your EBITDA if you want a starting point.
Look at your income statement/Profit and Loss 1.
Locate net income at the bottom of the income statement 2.
Pinpoint interest expenses and taxes, situated within the non-operating subcategory of the expenses section 3. Identify the figures for depreciation and amortization, found in the operating expenses subcategory of the expenses section 4. Calculate EBITDA! There’s two ways to do this: 5.
a.) Add up the net income, interest expenses, taxes, depreciation, and amortization figures from the income statement. b.) Alternatively, the second option entails adding the operating income, along with the depreciation and amortization figures from the income statement, to derive your EBITDA
Earnings (net Income) : + Interest Expenses: + Taxes: + Depreciation: + Amortization: = EBITDA:
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Finding the right talent, identifying and attracting individuals who not only have the required skills but also fit your group practice culture can be difficult for Visionary Leaders. And, while finding the right talent is one part of the issue, dealing with the high level of competition for talent compounds it further Group practices with less than 25 employees regularly compete with larger, more established companies that often provide higher pay, more comprehensive benefits, and more stability and face unique challenges recruiting enough candidates to fill open positions.
A June 2024 publication of The Economic Daily by United States Bureau of Labor Statistics (“BLS”) highlighted something that Visionary Leaders are already sensing: scaling a group practice in 2024 is proving to be more difficult than ever, in large part, due to the rapid expansion of the industry. In business, rapid expansion is both a blessing and a curse
For context, from an employment perspective, the average rate of growth in employment across all business sectors is around 3%. The current rate of growth in employment in the mental health industry is 18%. Over the next decade, the BLS estimates that there are projected to be 42,000 mental health counselor job openings each year The specific professional in highest demand will have the ability to work with clients experiencing addiction, anxiety, stress, and other problems.
To their benefit, most Visionary Leaders do
things with a sense of urgency They regularly innovate, create, and push boundaries. These are necessary, powerful talents that help Visionary Leaders push past uncertainty, unwavering to their goal. However, applying these same natural talents in hiring can have a negative overall effect Balancing the need to hire quickly to support growth with the need to thoroughly vet candidates to ensure they are the right fit Here are some top tips and best practices that our team of human resources experts has flushed out:
Nurture passive candidates in your network. Passive candidates are professionals who currently work in the job you’ll hire for in the future and would be open to discussing a new job, but your practice is not hiring right now
How to engage passive candidates: Leaders who are regularly engaged in hiring should consider having a presence in the community and on social media where they “talk about” what it is like to be an employee at your practice, marketing employment to passive candidates One way to take action in this area is to publish related content or resources to your network. Consider a one-sheet or social media post with “Top 10 Success Tips for Therapists in Private Group Practice,” to keep clinicians interested in staying in touch with you, and possibly being a part of your team. Hiring managers should build their network with people they may wish to interview one day
Implement the use of a talent acquisition (“TA”) platform to help streamline your hiring process and save time. A top priority in hiring is ensuring efficiency and maximizing efforts. TA platforms, like our favorite, JazzHR, provide
leaders with the ability to post jobs across multiple platforms with one click, manage all applications in one place (rather than logging into multiple job boards to monitor applications), automate communication with qualified candidates, share feedback across the organization, schedule interviews for multiple hiring team members in one place, and more Having candidates that apply through various job boards all screened in one platform saves users hours of effort on each job posting by allowing the practice to cast a very wide net and manage it all in one system.
Keep your job posting up-to-date and ready to go. Writing a magnetic job posting, one that showcases your employer brand, markets your practice well, and draws the right candidates to you will include a mixture of successfully describing your organization’s mission and values, and providing a realistic snapshot of job duties and key responsibilities, as well as critical skills that a person needs to be successful in the role on day one.
Do not cut corners to save time. Implement a comprehensive, multi-step process that includes multiple participants from your organization whenever possible. Hiring teams often consist of human resources or administrative support team members who conduct initial phone screens, experienced clinicians who may be a peer to the new employee, and of course, leaders from various part of the organization (clinical leadership and administrative leadership) Having a multistep process may include an initial application (written) plus a resume, a phone interview, an interview with a potential peer and clinical supervisor, and finally an interview with top leadership. Visionary Leaders may consider outsourcing some steps in the hiring process to
their internal administrative team, a recruiter, or HR consultant to ensure that they avoid the stress that may come by leading a multi-step process that feels unnatural to them.
Ask screening questions that explore values and align with the essential responsibilities and the skills required on the job. For example, if a Visionary Leader is hiring for a licensed clinician role, a question to ask on the initial application may be, “Please describe the type of clients that you prefer working with, and why.” An important in-person interview question might be: “Tell me about a time that you got behind on required documentation Why did it happen? How did you correct the deficiency? What, if anything, did you do to prevent it from happening again?” Consider creating a standard “scorecard” that all members of the hiring team use to compare top candidates help promote consistency in hiring. Common scorecard categories include education, special licenses or certifications, directly related experience, communication skills, client service orientation, and overall culture fit
Finally, don’t skip the basics to get someone on board fast! Invest time checking references and verifying past employment. If references are hard to get ahold of or don’t share a glowing recommendation, this is generally a red flag, as candidates typically provide the names of people in their network who are willing to market their best qualities When verifying past employment, even if the past employer will not provide details about a person ’ s past performance, it is imperative that you verify dates of employment, job titles held, and if possible, ascertain if the candidate is eligible for rehire Of course, it
can take several days to complete this process, but too many times, we see teams that suffer with toxic team members or underperformers who could have been weeded out when they couldn’t provide references and aren’t eligible for rehire with past employers
However you go about designing your process, keep the Overall Goal in Mind: hiring to maintain organizational culture and serve more clients
Particularly important to Visionary Leaders is the ability to maintain company culture, preserving the practice’s original culture as it grows, ensuring that new hires align with the practice’s values and work ethic while expanding the team. Leave your mark on the process as you grow your practice Invest time teaching your team how to hire like you To do this, focus on carefully designing and delegating systems in screening, hiring and onboarding that focus on educating candidates and new employees about how to be successful in your unique practice which will lead to success in the future!
Write down the names of your team members, and whether they fit Kim Scott’s definition of a rock star or super star. Next time you have a leadership opening, take a look at your superstar list. And make sure you give your rockstars recognition.
Rockstars like stability. They like doing their work to the best of their ability, Aren't looking to get the next job Enjoy being in the swing of things/ being the rock-solid part of the team.
Superstars want movement. They enjoy moving within their career
They look for new opportunities They are open to change from their current position
ine a group practice in which the White essionals in leadership can talk about race nonnsively with skill and nuance. Imagine an nization that makes space regularly for unpacking l, power, and privilege dynamics and actually follows gh to address them. Imagine this work not solely g on people of Color to lead the cause of racial e in clinical practice and building a positive racial ate in the organization Imagine a group practice e the psychology on race was as well understood as noses and treatment
be your practice is already there, wonderful. Many of eed your help to figure out how to build more acist practices.
almost 10 years of training (and studying how to white therapists to be more racially responsive, I if I could only choose one thing to teach, it would be l identity theory But it wouldn’t be enough just to the knowledge, my wish would be for therapists, rvisors & business owners to know how to use racial ity theoretical framework to improve their racial onsiveness skills.
say the words racial identity development a When you say them I totally disconnect I feel bored confused and I don’t know what you are talking t ”
piece of feedback was a gift I received from an rienced White psychologist a few years ago. As a e cis-woman, the bulk of my socialization of thinking, ng & teaching about race happened in graduate ol when I was already 25. Don’t get me wrong, a lot been communicated to me about race as I was raised in rural Oklahoma but there were much fewer words
“Being equipped with the tool of recognizing White racial identity schemas gives us a compass to navigate racism in our world, for its oppressive tools are complex, widespread, insidious, and highly effective.”
Therefore, I am challenged with the task of not being boring.
My challenge is to make sure I’m not taking an extremely emotionally evocative topic like racism, and specifically racism in mental health sound intellectual, impersonal, and distant And, maybe more important, my challenge is to be a humble yet persistent steward of Racial Identity Theory, recognizing that this knowledge did not originate from me.
My blessing, as I have come to realize, has been the opportunity to work with the phenomenal Dr. Janet Helms - the woman who did originate White Racial Identity Theory. Many, many people have been moved by her work, even without the chance to be asked in conversation the most thought-provoking questions about race One of my many privileges in life has been to be confounded, bewildered, and somehow at the same time deeply known by the greatest mentor I’ve ever met.
Thankfully, she brings theory to life in her book A Race is a Nice Thing to Have. If you read the short book (I had to read it several times) you will start to build your language on how you tend to respond to racial events or stimuli in your life
You might notice you feel completely shocked and dysregulated when you learn something new and horrifying about race and think “Oh, I’m using my Disintegration schema.”
Or, you might want to rest in the space of “I’ve done my work on race ” and yet miss the mark and wound a person of Color and realize, “It seems like I used my Pseudoindependent schema in that dynamic ”
Or, you might be angry Really angry and almost indignant to White people earlier in their racial identity
development. You might even be alienating yourself so you feel woke but alone. And then you might reflect, “Oh hello, Emersion.”
Each schema is characterized by a set of thoughts, feelings, attitudes & behaviors on racial stimuli We each have profiles that include one or several of these schemas in response to race and racism Ideally, we move through the developmental spectrum of White racial identity towards further maturity and selfactualization.
This model, like most psychological developmental models, is a nonlinear progression and we can certainly get stuck at any point. I often compare the developmental process to the way we understand moving through grief In this case we are grieving the illusion of equity, the loss of racial innocence, letting go of unearned privilege & power, and the delusion of White supremacy.
Being able to identify racial identity schemas offers us another incredible benefit – improving our relationships.
While many people are familiar with Dr Helms’ work on White Racial Identity Theory, another lesser-known theory - the Racial Identity Social Interaction Model (RISIM) is truly my favorite to apply to interpersonal dynamics, especially the ones that happen at work and in therapy.
The RISIM or SIM beautifully integrates the concepts of the psychology of social power with racial identity development What is the psychology of power? This theory, developed by French & Raven in 1959, refers to the kinds of ways people hold and use power to influence others’ behavior In therapy & supervision, we
are well-trained to understand the imbalance of power and its complex role in providing good care, good training, and good leadership overall.
So, what happens when someone with more power than you (in therapy, in supervision, in leadership) is at an earlier point than you in their racial identity development?
A great deal of research has been done on the effects of what we call in RISIM a regressive relationship. When you are in a regressive relationship, you likely know it. The literature identifies regressive relationships, ones where your therapist and supervisor has a less advanced racial identity than yourself, as unsupportive, invalidating, ineffective, and in many cases harmful
You are in a progressive relationship when the person that holds power over you has a more advanced racial identity. An exceptional example for me was my relationship with Dr. Helms. Having the opportunity to be in a mentoring relationship with someone so knowledgeable and skilled in advancing my racial identity likely helped me to understand how unique that relationship can feel as a white person.
You are in a parallel relationship when the person who holds power over you primarily utilizes the same or similar racial identity schemas I expect this to occur frequently, especially for white therapists Although this may be a very pleasant experience in the context of race, it may be insufficient in a supervisory or leadership capacity especially when both professionals are White and providing therapy to people of Color.
Being able to label racial identity relationships
can be a godsend This is most true when you are the person in the relationship with less power because you may have some intellectual protection against the gaslighting & scapegoating that comes with the territory of regressive relationships.
We all have psychological relationships with our institutions. I’m guessing we are hardwired for this.
Each institution or organization has a racial climate, which includes how people feel about the practices, policies, and culture around talking about race, responding to racial events, and understanding tools of oppression like privilege
Our perceptions of racial climate represent the relationship between our racial identity and the organization's racial climate.
Dr Helms has extended the RISIM into examining the racial climate of an organization so we can determine when we are in a regressive relationship with not only those in power over us but also the system.
Do you notice yourself afraid to threaten the culture of kindness of your organization by bringing up racial injustice? This fear of unkindness might tell us a lot about the racial climate of your workplace When politeness is prioritized, most often than not systems prioritize the comfort of White and other privileged groups. In this case, you may be in what Dr. Helms calls a multicultural racial climate.
Furthermore, she and other researchers
including myself, have examined how our institutions support or punish racially responsive supervision and therapy. For the most part, we have found that institutions are not generally supportive for racially responsive supervision.Furthermore, women of Color in middle management (supervisors and the like) tend to face the harshest punishment from leaders and systems in their efforts to promote racial responsiveness
In short, the recommendations listed by Dr. Helms and other experts encourage leaders to learn how to: 1) assess their own racial identity in response to racial stimuli, 2) assess the kinds of relationships they offer as leaders in the institution, and 3) assess the racial climate of their organization.
Even better, in order to adequately address racial dynamics and target racism (in all its evasiveness) employees learn to use shared language to assess relevant racial identity schemas that arise when race is talked about
and/or avoided Of note, racial climate and identity is possible to assess from the presence or absence of policies alone, including the extent to which employees feel the policies are actually followed through on
Carving out paid and protected space for race and racial identity training has long been suggested in the literature for clinical training and organizations, but I expect what is missing is a true examination of the kind of followthrough needed to experience sustained growth and change in racial climate. Racial identity and racial climate development take time, effort, courage, resilience, and money.
There are many excellent consultants and trainers who can support your own racial identity development, help assess your racial climate, and develop appropriate and effective interventions to promote growth and change. Please contact me at stephanie@throwerconsultingandtherapy.com for tailored recommendations.
One of the first steps to stepping back is redefining your role. Whether you are ready to step back today or years down the line, understanding your new role as CEO is integral in transitioning your team to function efficiently and smoothly without you handling the day-to-day processes.
So to support you in creating that plan, take a look at this role breakdown (from Maureen’s Masterclass Stepping Back) to support you as you braindump ideas. (And remember, as you step back these details may shift as your biz does.)
Visionary
Newventures Retirement
Volunteer/philanthropy
Newstreamofincomeidea generation
Partnerships/relationshipbuilding
Practiceculture
Pulseonindustry
Research&development
Whatthingsdoyou currentlydooutsideofthe oneslistedtotheleft? Whichleadershiprolescan assumethose responsibilities?
What would you like to see yourself ideally doing as you step back? Think outside the box. What’s your caseload like, what tasks do you ‘ own ’ (if any), and what things are you doing that light you up?
What do you need to delegate or let go of to get your ideal CEO role after you step back? Think about what you ’ re still managing.
What can you eliminate in your daily tasks?
What can you simplify in your processes, such as Automating some systems or Delegating your tasks to other team members
Can you reduce your client caseload?
How can you expand your leadership or admin support to get more off your plate?
Thoughtleadership
Newstreamofincomeideageneration
Partnerships/relationshipbuilding
Practiceculture
Pulseonindustry
Research&development
Whatthingsdoyoucurrentlydooutsideoftheoneslistedtothe above?
Whichleadershiprolescanassumethoseresponsibilities?
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