The Visionary Issue 4

ISSUE 4

THE VISIONARY LEADING THE WAY IN GROUP PRACTICE INNOVATION THE FINAL ISSUE

you’ve been served. now what?

The Neurodivergent Guide to Proactive Approaches in Group Practice Ownership HIGH ACHIEVERS VS HIGH PERFORMERS

NEUROINCLUSIVE WORKPLACES MENTAL HEALTH LEGISLATION

INCREASING PASSIVE INCOME WITH SELF PUBLISHING

MENTAL HEALTH WORKFORCE SHORTAGE TELETHERAPY REGULATIONS POST PANDEMIC

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

GRAB YOUR COPY THE ACCOUNTABILITY EQUATION™

BRIDGING THE GAP IN ACCOUNTABILITY AND IMPACT BY: MAUREEN WERRBACH

AVAILABLE ON AMAZON

Issue 4

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

HR ANSWERS Fractional HR services C-SUITE BOUTIQUE Fractional Integrator services

CONTRIBUTING WRITERS

ANTIRACISM REVOLUTION A membership community for collective liberation

Rachel Murdock, MS, LPC, LCPC, LMHC Owner/Clinician, Beyond the Storm Behavioral Health, LLC

CLINICAL SUPERVISION DIRECTORY A directory to connect clinical supervisors and supervisees

Dr Gerda Muller Owner/Clinician, Group Practice Owner

ADMIRRA Client relationships and management software

Kelli A Fowle, LICSW CAGS Play Therapy Candidate, Group Practice Owner Dr. Colleen Cira Owner/Clinician, Cira Center Dr. Brittany Woolford, Ph.D. Owner and Psychologist, Lone Wolf Psychological Services

@THEGROUPPRACTICEEXCHANGE #THEVISIONARYMAGAZINE WWW.THEGROUPPRACTICEEXCHANGE.COM

www.thegrouppraticeexchange.com

02

Issue 4

THE VISIONARY

IN THIS ISSUE 5

You’ve Been Served

9

High Achievers vs. High Performers: Shifting from Busy to Effective

13

The Neurodivergent Guide to Proactive Approaches in Group Practice Ownership

20 26 29 32 36

From Unseen to Understood: How Neurodivergent Leaders Can Foster Inclusive Workplaces Teletherapy Landscape

Regulations

Post-Pandemic:

Navigating

the

Changing

The Mental Health Workforce Shortage: Solutions for Group Practice Owners Mental Health Legislation and Insurance Coverage: Evolving Landscape for Group Practices

Navigating the

Increase Passive Income Through Self Publishing

www.thegrouppraticeexchange.com

03

Issue 4

THE VISIONARY

FROM THE EDITOR

Dear Visionaries, As we close out this year of Visionary magazine, I’m feeling a mix of pride, gratitude, and maybe just a little bit of “Ican’t-believe-we-made-it!” This issue marks our last for now, wrapping up a year of conversations, insights, and bold dives into the challenges and triumphs of being in this wild world of mental health.

This issue hits close to home for many of us.

We’re talking about neurodivergence in the workplace and leadership—a topic that’s personal for me as an autistic and ADHD entrepreneur. We explore what it means to be a high achiever versus a high performer, and how those distinctions can shape our success and sanity. There’s also guidance on increasing passive income through selfpublishing (because who doesn’t want a little more freedom?), and crucial advice on managing the unexpected when you’re served as a group practice owner.

I’ve also contributed a few pieces on pressing issues that affect us all: the ever-evolving landscape of teletherapy post-pandemic, navigating the mental health workforce shortage, and the ongoing fight for better mental health legislation and insurance coverage. These are the conversations that need to keep happening long after this magazine pauses.

Thank you for being part of this journey with me. Whether you’ve been here since the first issue or you’re just diving in now, your passion for this work is what makes it all worthwhile.

This isn’t a goodbye—it’s a “see you soon.”

Keep leading, keep learning, and keep pushing the boundaries of what’s possible in your practice and beyond.

Until next time, Maureen Werrbach, LCPC Editor-in-Chief, The Visionary

www.thegrouppraticeexchange.com

04

You’ve Been Served Rachel Murdock, MS, LPC, LCPC, LMHC Owner/Clinician, Beyond the Storm Behavioral Health, LLC

THE VISIONARY

You have been served - these four words bring about a sense of dread in mental health practitioners. Being subpoenaed to testify has historically caused panic in a field where confidentiality and the clinical relationship is of the utmost importance. When mental health practitioners think about court testimony, they often think about disclosing what was shared privately in a session or being asked to portray their client in a negative light, both of which feel cringeworthy.

What if I told you that testifying in court can be a great experience, an additional income stream to highlight your areas of expertise, and can be done in a manner that protects the mental health practitioner and the client?

Picture this - A judge is trying to make a decision in family court about a child returning to live with their biological father, after several years of no contact due to allegations of child abuse. The child has been questioned multiple times by multiple people (a no no in child abuse investigations, as this can complicate the information coming in) and conflicting information has been gathered. Here is a sample of the information I may share with the court in a case like this – As human beings, it can be painful to discuss traumatic events that have happened to us and children are no exception. Children and adolescents may struggle to discuss their abuse due to the relationship with the perpetrator, the impact of trauma on memory, and/or consequences or perceived consequences of reporting the abuse.

Children may not report abuse when it is occurring, may deny it and may delay disclosure for months, years, or even into adulthood. Disclosure is determined by an interplay of victim characteristics, perpetrator characteristics, family environment/support, and societal factors.

Impediments to disclosure may include age, development, non-offending caregiver support promises, threats, relationship to perpetrator, or fear of causing trouble in the family.

Disclosure is almost always a process for victims of childhood sexual abuse. It is rare for a victim of childhood sexual abuse to disclose all details of their experiences to any one person, and it is also rare for victims of childhood sexual abuse to

www.thegrouppraticeexchange.com

Issue 4

disclose every incident of abuse in any one disclosure, if ever. Statistics regarding the rate of disclosure vary, due to underreporting of child abuse in general, and range from 24% to 96%.

Research suggests that up to 60% of child abuse victims may wait more than five years to disclose about their abuse experience.

Trauma can also impact the disclosure process.

Specifically, the experience of trauma can influence a child’s ability to recall detail. Research suggests that memories for traumatic experiences are not easily recalled and this may be due to the encoding process that often takes place when we experience negative events. Things that are shallowly encoded, possibly due to inattention or dissociation during the negative event, may not be clearly recalled. Memories for traumatic or negative events often have less sensory detail, but more meaning and impact, than positive memories – which is likely due to cognitive avoidance strategies used while experiencing a negative event.

In the case referenced above, the judge made the decision that the child should continue to have no contact with her father, which I believe was the right decision, given the evidence available.

To level the playing field, I want to provide some operational definitions to ensure we are all on the same page. An expert witness is someone who has specialized knowledge, training, and/or experience in a particular topic of interest to the civil or criminal justice system based upon the particulars of the case that is being tried. This expertise allows the expert to provide informed opinions and educate the judge and/or jury about matters of concern. Testimony is just part of an expert witness’ role – a lot of preparation happens on the front end to review materials, discuss research, write expert notices, etc. An expert witness’ testimony can help inform the court’s understanding of various topics and their relevance to the legal matter(s) being explored.

An expert witness is hired by either prosecution or defense, but objectivity and neutrality are still important considerations. While expert witnesses are very important to court cases, they are one piece of the puzzle, and the entire case is not on their shoulders.

06

Issue 4

THE VISIONARY

Expert witnesses can provide specialized knowledge and professional opinions on a variety of topics. I am qualified as an expert witness for the United States Government, Missouri and Kansas in topics related to child abuse disclosure, compliant victimization, trauma responses following victimization, matters involving human trafficking victimization, online exploitation of children, and typical reactions following victimization than can be expected. I am lucky to have a unique background as a forensic interviewer, both for a local agency and the Federal Bureau of Investigation, to have started to set the stage for me to begin developing expertise in these topics. I have conducted nearly 3,000 forensic interviews as part of my clinical career and as I have shifted back into mental health treatment over the past 18 months, I enjoy being able to testify on educate the court system in matters that will help the court make informed and fair decisions.

Mental health professionals may be asked to testify on matters related to competency, child custody and parental fitness, addiction/substance use, brain development, trauma and its impact, mental health diagnoses, symptoms, risk assessments, and disability and other impairments. It is important that the mental health professional have the education, experience and skills to thoroughly discuss the topics being asked to address to the court. It is important to maintain up-to-date knowledge in the field, participate in continuing education opportunities, and review and publish research in peer-reviewed journals.

In preparation for court testimony, it will typically involve a thorough review of case materials, an initial expert notice with opinions (to be turned over to the opposing counsel for review), anticipating potential questions, challenges, and areas for potential discussion. This will often result in opposing counsel attempting to limit your testimony/ensuring you are speaking within your scope of expertise.

would argue that as someone’s clinician, I may have better insight into what is best for their mental health than many others in their lives, so I would love to opportunity to advocate for my client in this way.

Of course, we want to consider the impact on the therapeutic relationship and confidentiality and privacy concerns. I personally testify most often for other people’s clients, so this helps protect the therapeutic relationship with their clinician.

If you are subpoenaed, don’t panic, you are the expert at what you do. When testifying, remember to only answer the question asked (it is the attorney’s job and not yours to circle back around to anything that was missed or needs elaboration), use language that is easy to understand versus clinical jargon (remember that juries may not all have the same education level and we are competing with inaccuracies portrayed in things like Law and Order), and maintain a calm and professional approach, even when your buttons are being pushed when you are being asked questions. Being argumentative is a huge turnoff for judges and juries, so you want to make sure you are mindful of your responses, both verbal and non-verbal.

After you testify for the first time, it is time for debriefing and self-reflection and feedback from the judge, jury and attorneys so you can learn and grow. There are always areas of improvement and the more we testify, the more comfortable we become with the experience.

I hope this encourages you to consider diversifying your income stream and day to day by considering what areas you are passionate about and could share with the public to fight for the greater good!

Court is adjourned!

If you are subpoenaed to testify on behalf of a client you are seeing in your practice (i.e. a fact witness) this can get tricky. Contacting your liability insurance is ALWAYS recommended, as they will help navigate the appropriateness of your participation, but with guardrails, even this can be a positive experience for you and for your client. I

www.thegrouppraticeexchange.com

07

High Achievers vs.

High Performers: Shifting from Busy to Effective Dr. Gerda Muller

Gerda is a Clinical Psychologist and founder of the award-winning group private practice, The Psych Professionals located in Brisbane, Australia.

I first came across the concepts of High Achiever and High Performer mode a few years back whilst reading an issue of the Harvard Business Review. As a Clinical Psychology graduate, these weren't concepts taught in my degree, but it was concepts that made a hell of a lot of sense in explaining my own struggle in building a psychology group private practice.

In delving more and more into this topic, I found that being a High Achiever is very different to being a High Performer - just like being Introverted is different to being Extroverted. Of course, just like the introversion-extraversion continuum isn’t an absolute, so the High Achiever and High Performer continuum isn’t an absolute. You can be either of the two across different situations, but you most certainly will have your personal default mode.

One of the biggest challenges I hear when I speak to practice owners, is their desire to step out of the Chief Operating Officer (COO) role and into the Chief Executive Officer (CEO) role within their business. It is

Issue 4

THE VISIONARY

a desire to step out of the day-to-day operations and into the visionary role of setting the strategic direction and trajectory of the business.

My hope with this article is to help you connect the dots of why you might be struggling with fully stepping into the visionary role. To connect the dots and leave some bread crumbs for you to follow as you move towards taking on this important role within your business.

I want you to start by reflecting on these concepts.

Are you a High Achiever or are you a High Performer? You might find yourself being pulled towards both, because both sounds pretty cool, but you most certainly will have a default mode – the one that you operate from most of the time.

Although they sound very similar, these two modes, are actually distinctly different.

High Achiever Mode Characteristics You feel like you are constantly pushing through your own emotional and physical limits to get stuff done?

You like to get your to-do list done, TODAY. You look for the ‘winning solution’ when problem-solving.

You experience a lot of self-doubt.

You are high on self-competitiveness.

You are never satisfied with your wins (always moving the goal posts).

Your effort comes from a not-good enough energy and needing to prove yourself.

You are driven by fear of failure.

You easily get stuck in perfectionism.

You’re a control freak.

High Performer Mode Characteristics You are able to leave dealing with problems till the next day.

You are always looking for the ‘optimal solution’.

You are able to keep self-doubt at bay.

You are low on self-competitiveness.

You are meticulous around your habits and routines.

Everything you do has a purpose.

You are good at pressing pause on triggers.

You are fiercely protective of your time.

You have filters/rules around how you make

www.thegrouppraticeexchange.com

decisions.

You take a long-term focus in all you do.

High Achiever Mode Characteristics If you’re a High Achiever, you are most likely constantly pushing through your own emotional and physical limits to get stuff done. In other words, no matter how tired you are, no matter how long the day has been, you just keep going. You are driven by getting your to-do list done whether that is before you leave the practice or for some of us before you go to bed.

As a High Achiever you are always looking for ‘the winning solution’ – the thing that will solve your current problem. You also find yourself experiencing a lot of self-doubt. Within the helping profession, this often manifests as imposter-syndrome and can lead to avoidance and procrastination.

The High Achiever is high on self-competitiveness, always competing with themself, always pushing themselves to be better, to do better. As such, High Achievers are rarely satisfied with their wins, meaning they are always moving the goal post, never really stopping to smell the roses. They are always thinking…. ‘Okay, so what's next?’.

The High Achievers effort to achieve is often driven by a ‘not good enough energy’ or a ‘needing to prove yourself energy’, whether that is to others or to themselves - this is an exhausting energy. High Achievers are also driven by a fear of failure and as such can get stuck in perfectionism. Needless to say, they are your typical control freaks.

If the High Achiever mode is feeling a tad bit familiar, please know this is not a judgement. It is an awareness. An awareness that will now allow you to ask: How is this mode serving me?

High Performer Mode Characteristics Your typical High Performer has the ability to ‘park’ unexpected problems. If a problem pops up, they will consciously decide to just let it be, so they can deal with it tomorrow. Rather than obsess about it and be driven by anxiety to deal with it right now, they have the distress tolerance to sit with the discomfort of not acting and allowing the problem to be solved the next day. This ability allows the High Performer to stay in CEO mode instead of being drawn into the operations of COO mode.

10

THE VISIONARY

Issue 4

In contrast to the High Achievers who takes a shortterm focus, the High Performer takes a long-term focus in everything they do. Whilst High Achievers are thinking about next week, next month and next quarter, the High Performer are thinking about next year, 3 years from now, 5 and 10 years from now.

Acknowledging your Mode Now, the moment of truth. Which mode is your default mode and how is this mode serving you and your business?

In contrast to the High Achiever, who is looking for ‘the winning solution’, a High Performer is always looking for ‘the optimal solution’. They are thinking about more than just quick or personal wins.

Instead, they seek long-term solutions that solve larger problems.

The High Performer is low on self-competitiveness, whilst being meticulous around their habits and routines, sticking to what works with disciplined consistency. Everything a High Performer does has a purpose. They don’t just do things because it’s on a to-do list, they do it for a reason. They don’t do things because a peer, colleague, friend, trainer or mentor told them to do something or because someone else is doing something - they do it because it has a purpose.

The High Performer doesn’t suffer from fear of missing out, instead they strategically choose what needs to be done. Being a High Performer means being good at pressing pause on triggers. They aren’t reactive, but instead will stand back to evaluate the situation before responding.

High Performers are fiercely protective of their time.

They've set and maintain good boundaries around their time adding to their productivity. In addition, they have filters and rules around how they make decisions, which adds a calm, clear and carefully thought-out process to their decision-making. This buffers them from decision-fatigue and burn-out.

www.thegrouppraticeexchange.com

It is my personal belief that many of us practice owners are stuck in High Achiever Mode and that this stuckness is holding us back from growing and scaling the business we truly desire and deserve.

The problem is that the school and university system required, sculpted and moulded us into being High Achievers. It is what allowed you to excel academically so that you could obtain your clinical qualification. Not to even mention the external reinforcement and validation you receive for being a High Achiever.

Similarly, a business also requires the unique qualities of being a High Achiever. High Achievers get shit done. They will work through the night and push through to achieve their goals. They have the qualities that will see you launch a successful private practice. However, in order to sustain a business and to scale it profitably beyond 7-figures will require a High Performer mode. In order to successfully lead a team that will be able to step into leadership roles, so you as the founders and owner can be the visionary, will requires you to acquire a High Performer mode.

The good news is that you can most certainly acquire the skills to operate as a High Performer. By reading this article and becoming aware of your default mode and how it might be serving you or potentially keeping you stuck was the first step.

From here you can start to catch, control and correct yourself from potentially falling back in High Achiever mode when High Performer is called for.

From here you can start to embody what it means to be a High Performer and actively seek out the skills required to make this your new default mode.

The time to become the visionary you were always meant to be is now.

11

5

Things To Consider Before

YOU HIRE AN INTEGRATOR

1

Are you ready for an Integrator?

Don’t jump the gun. Hiring an Integrator might seem like a magic solution to all your work issues. But it’s a big risk if you’re not ready. You will need to have the budget, an established leadership team, a willingness to let go of control, be comfortable with uncomfortable conversations, and the ability to stay in your own lane.

2

Finding the right fit:

Understanding what makes someone a good Integrator is key. The person you choose should possess the right traits and characteristics, be in close alignment with your vision and values, and have the skills and ability to carry out their responsibilities.

3

Hiring internally vs externally:

Hiring internally can seem like a quick and easy solution.

You could get someone in place quickly and at less cost.

But what if they aren’t the best fit? An external candidate will take more time to find, but you might have a better chance of finding someone who is a good fit long term.

4 Fractional vs. Full time Integrator:

An Integrator is a highly skilled position. Hiring a fulltime Integrator will require a sizeable budget. A smaller business might benefit from hiring PT. You will avoid paying a hefty price tag for your Integrator to fill lesser skilled roles.

5

What level of support do you need?

Do you really need an Integrator? There is a continuum of operational skills. One one end of the continuum are your task masters like administrative assistants. On the other end are strategic decision-makers like Integrators.

What you need might actually be somewhere in between – like a director of operations or a practice manager.

www.c-suiteboutique.com

The Neurodivergent Guide to Proactive Approaches in Group Practice Ownership Kelli A Fowle, LICSW | CAGS Play Therapy Candidate | Group Practice Owner

In embracing my ADHD superpower, and

we instead planned for the worst and hoped

assessing my challenges, I have found there

for the best and took steps along the way to

are core principles that I live by to run a

avoid the worst. If we can try and predict

strong team and lead a group of people I am

outcomes, we can try and take actionable

proud of. Something I have used as my

steps toward our own desired outcomes. I

greatest defense with my brain is to be

have built my business around proactive

proactive with all things. My core belief is

approaches

that proactive approaches to most things

employee needs and am thrilled for the

albeit

opportunity to share.

communication,

foreseeable

to

industry

trends

and

difficulties, meal planning or relationship issues is a magic strategy that can work

Burnout Prevention: There is not a full

wonders for family and work cultures. Our

recovery from burnout. A study at Harvard

society is set up to be reactive to everything.

University

found

Social media posts, politics, reform, and

epinephrine

surges

pandemics for some examples. But what if

vessels

arteries, increasing blood

and

that can

“Persistent

damage

blood

THE VISIONARY

pressure and raising risk of heart attacks or strokes. Elevated cortisol levels create physiological changes that help to replenish the body's energy stores that are depleted during the stress response.”

(Lewine, 2024) The study interestingly found that often this response is happening without the person realizing it, which means by the time you feel stress, it is often too late to combat the longterm effects. I have sat through hundreds of courses on burnout and all of them were about reactive responses to stress, responding to signs of burnout rather than preventing it in the first place. The amount of stress, and sadness we carry to do our jobs cannot be understated and we need to be able to take time away. As one measure of burnout prevention, I offer my full time employees unlimited PTO, and complete control of their schedules, so long as they are meeting standards of productivity they can manage their lives how they wish. For example, I have a person that likes to work weekends so she takes 2 days during the week off, and another who treasures her weekends and would rather work late into the evenings during the week. Trusting my employees to manage their own lives has created a vibrant culture where they trust and appreciate my business and also grow into their roles with their own autonomy and what makes sense for their own lives. I also make myself available for zoom office hours twice per month where staff can check in with me about anything on their mind.

Passion: The neurodivergent. brain is

www.thegrouppraticeexchange.com

Issue 4

drawn to what it finds interesting and meaningful, so it is essential that you believe in and enjoy what you are doing. I do not look at my work as a job but rather my life’s work. Owning my business, helping clients, and helping other therapists through proper coaching and career building fills my cup immensely. It has also helped me to niche my skills and have control over my caseload, taking on clients that fall within my niche rather than assigned clients that may not be the best fit. When my employees meet monthly for group supervision we often talk about the goodness of fit, and make sure that therapists have clients on their caseload that they feel passionate about helping.

Delegating: Years ago, I would have been afraid to delegate, feeling like I SHOULD be able to do it all, or I would have felt this alone made me incapable of owning a business. Through recognizing my own strengths, and what challenges I face, I look at my metrics prior to hiring and see where the practice is lacking, or how we can get a better reach toward our mission. Recently, I realized that we needed more therapists that specialized in men’s health and life issues, so I am now hiring specifically for someone who can fit and improve this metric.

Hiring: Hiring the right people is key to my success, not in terms of on paper qualifications but I also must really like their personality, and they must have strengths to counteract my challenges. I struggle with people I do not like, or that do not have similar values to mine in my

14

THE VISIONARY

life and it always made me feel like a bad and intolerant person until I realized that this is just the way my brain works. I can have a deep connection to others that share my values, but I am not willing to put the work into superficial relationships, or with someone I do not foresee a connection with. It took me even longer to realize that this also should apply to my sueprvisees. Recently, I hired a brand new to the field clinician as a part time therapist because her personality was delightful, and I knew I could train her to do the job and help her overcome her imposter syndrome. Last month she joined me full-time. I believe that liking your employees is one hundred percent essential.

Transparency: I know that I will forget emails, administrative tasks, or even meetings sometimes (I am getting better at this) and I tell both clients and employees ahead of time that they can always feel free to remind me or let me know if I am making them frustrated or upset due to my challenges with something. I also share with clients that organization, or email communication is not a strength of mine and what to do when they do not receive a response right away, or how to alert me if something requires my attention.

Another part of proactive transparency, is recognizing that through the internet, AI, social media, etc. our world continues to get smaller and the idea of privacy is even more nuanced. It is interesting to me that in graduate school we learn about strong boundaries, and the therapist

www.thegrouppraticeexchange.com

Issue 4

being a neutral, blank canvas for the clients, but I don’t think this works anymore and quite frankly, it would be a welcomed change if curriculum, ethics and board standards could adjust. I subscribe to a more wholesome approach, where I use self-disclosure when appropriate, and use my personality to connect with clients.

Thinking of being in their shoes I would not feel safe being vulnerable with someone that I felt did not understand me or that has not walked through challenging paths themselves. In my experience, clients appreciate my approach. I do have a social media policy to the intake paperwork around differentiating a personal social media page versus a business social media page, but also acknowledging to clients how we will handle seeing each other in public, or how I will manage their confidentiality if there is mutual third party relationship. I live and work in neighboring small towns and it is impossible to not see a client out, or at a community event. Being transparent that things can happen and planning for what both client and clinician are comfortable with is a proactive way to approach these situations. My staff have also commented that it is helpful to be in a space where we can realistically talk about the challenges of our industry, and realistic ways to navigate them. A good therapist is realistic about the environment and challenges for our clients. We cannot control every aspect of life, but planning on how we will handle these interactions has been useful in preserving relationships.

15

THE VISIONARY

Talk about Therapy often: My own therapy has been transformative in my ability to run a business. Confronting the parts of myself that feel unworthy or are fearful has been powerful. I constantly talk to my therapist and really could not be where I am without them. It circles back to my belief in this work, but also elicits empathy for my clients for how hard it is to be in that seat. My own therapy appointments also keeps me accountable to reflect and work on my own “stuff” that can get in the way of common sense and logic. Even when things in my life are going well I continue to use therapy as a place to grow, and I use the more “quiet” times to improve the strategies I already have and to explore core beliefs that may not be serving me. I encourage my employees to have their own therapists and often share with them how useful it can be for anyone doing this work. It is a good rule that all good therapists need a good therapist.

Issue 4

And finally...Grace: In my family, mistakes were things that other people did. If I made a mistake or forgot to mask or cover up the mistake I made, it often led to punishments from others, and even worse punishments from myself. I thought success meant perfection, and often, knowingly, or not, I was in environments that reinforced the fixed belief. You cannot recover from mistakes” Overtime, I have embraced my mistakes as sincere learning opportunities, and I encourage my employees to learn from mistakes as well. Additionally, I teach clients about grace and how they can use it with others, and themselves. Life is not clean cut, and when we expect it to be, or try to force it to be, it can lead to increased stress and anxiety. Teaching and learning grace are transformative.

References: Lewin, Howard. www.harvard.edu.

“Understanding the Stress Response” 2024.

WHAT IS EBITDA? 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.

CALCULATING YOUR EBITDA 1. Look at your income statement/Profit and Loss 2. Locate net income at the bottom of the income statement 3. Pinpoint interest expenses and taxes, situated within the non-operating subcategory of the expenses section 4. Identify the figures for depreciation and amortization, found in the operating expenses subcategory of the expenses section 5. Calculate EBITDA! There’s two ways to do this: 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

PLUG IN YOUR NUMBERS FOR YOUR EBITDA Earnings (net Income) : + Interest Expenses: + Taxes: + Depreciation: + Amortization: = EBITDA:

NEED MORE SUPPORT?

From Unseen to Understood:

How Neurodivergent Leaders Can Foster Inclusive Workplaces DR. COLLEEN CIRA DR. COLLEEN CIRA IS A QUEER AUDHDER PSYCHOLOGIST AND SPEAKER DEDICATED TO NEURODIVERGENT ADVOCACY AND COLLECTIVE LIBERATION. SHE IS THE FOUNDER AND CEO OF CIRA CENTER FOR BEHAVIORAL HEALTH, A MULTI-LOCATION PRACTICE IN CHICAGOLAND, AND CIRA CENTER CONSULTING, BOTH FOCUSED ON EMPOWERING INDIVIDUALS TO IDENTIFY AND DECONSTRUCT BARRIERS THEY FACE SO THEY ARE FREED UP TO CREATE THE LIFE OF THEIR DREAMS.

THE VISIONARY

Before starting my group therapy practice, I never felt like I belonged in any workplace. I always felt too much—cared too much, tried too hard, cried too often. Despite meeting and often exceeding expectations, I constantly wondered why people reacted so strongly to me when all I wanted was to do my best and be liked. It was exhausting, and no matter how hard I tried, I still felt like an outsider.

I couldn’t understand how leaders who claimed to care about their employees could make decisions that seemed, at best, neglectful and, at worst, harmful. Why didn’t they seem to care about what mattered most to their employees?Why weren’t they open to shifting policy if it allowed their most valuable people to stay? Instead of directly addressing staff concerns, meetings would simply be piddled away and ended abruptly, seemingly to avoid the elephant in the room. The lack of direct communication and transparency was baffling and infuriating.It was disheartening to see organizations project an image of integrity while acting in ways that contradicted those values behind closed doors. Employees needed to play by the rules of the organization, but the organization seemed to care less about the ethics and regulations required of them. The lack of direct communication and transparency baffled me.

I longed to fit in, to find a community—a work family where I felt safe, comfortable, and cared for. But every time I thought I was close, that dream slipped away, leaving me stuck in the same cycle of self-doubt: "What is wrong with me? Why can’t I fit in? Why can’t I just go with the flow like everyone else?"

That’s when I realized that if I kept searching

www.thegrouppraticeexchange.com

Issue 4

tfor this ideal work environment, I would never find it—I had to create it myself. Starting my business was more than just founding a company; it was embarking on a life path centered on understanding who I am, recognizing what I truly need, and learning to honor those needs unapologetically.

I am a Queer AuDHDer, but I didn’t know that back in graduate school when I was navigating one work setting after another, trying to build skills and find my place in the world. Looking back, I have so much compassion for my younger self—life was incredibly hard then, and in many ways, it still is. But now, I know myself so much better, and I've realized that my needs aren’t so different from many others.

To me, neuroinclusivity means recognizing that we all have unique brains, nervous systems, lived experiences, and needs, and our environments should reflect that truth. It’s a simple concept, yet we’ve been conditioned to believe there’s only one "right" way to be— either you fit the mold of "professionalism" or you don’t; you’re "buttoned up" or you’re not.

This binary thinking dictates that one way is correct and anything else is wrong, but that’s complete nonsense.

And whether you think it’s nonsense or not, just look at our world, let alone our workspaces, to see that this “one right way” approach isn’t working. Employee disengagement is rampant, costing companies billions, largely because workplaces are not designed to support diverse neurological needs.[1]. Only about 50% of U.S. employees view their leadership team's performance positively, while 24% rate their leaders as performing poorly or very poorly.

[2]. More than one-third of employees would

21

THE VISIONARY

consider leaving their job within a year if they feel undervalued, and 79% of those who have quit cited feeling undervalued as a main reason for their departure.[3]. About 40% of employees believe their managers ignore their requests and do nothing to improve morale, harming satisfaction and retention.[4].

All of this raises a crucial question: why are employees so dissatisfied? While the answer is complex and multifaceted, I believe neurodiversity plays a significant role.

Neurodiversity refers to variations in the human brain and nervous system that differ from what is traditionally considered standard. It includes conditions like ADHD, Autism, and other mental health challenges, which are often misunderstood or overlooked in typical work settings. According to the 2024 State of Workforce Mental Health Report by Lyra Health, many employees find their mental health affects their job performance, with a significant number considering quitting due to these struggles. Moreover, recent research indicates that only 10% to 25% of adults with ADHD are correctly diagnosed, and a CDC study suggests that 5.4 million adults in the U.S. are Autistic, though many may be undiagnosed or misdiagnosed with conditions like depression or anxiety.

Clearly, this is an issue…so why are we, as employers, not taking this seriously? tConventional workplaces often reflect dominant culture paradigms that prioritize conformity over authenticity, sidelining those who don't fit the mold. We need to shift towards environments where diverse brains are seen as assets, not anomalies.

Current research is clear that this isn’t just a fun vision of the future, but rather our reality

www.thegrouppraticeexchange.com

Issue 4

right now. ADHDer’s are often creative, energetic and adaptable, leading the way with their problem-solving, flexibility and ingenuity[1].

Their ability to intensely concentrate on tasks they enjoy means that when they are working on projects they love, they can demonstrate exceptional productivity and attention to detail. Their bubbly energy and enthusiasm are often contagious, boosting morale.

Autistic folks often have exceptional pattern recognition skills, tend to be less likely to influenced by societal norms and typically have a strong work ethic[2]. Their direct communication style often makes it easier to meet their needs. Anxious individuals tend to be very conscientious employees, striving to exceed expectations[3], while those who struggle with depression often have heightened empathy.[4]. The list goes on and on.

So, if you’re convinced and recognize that you likely already have neurodivergent employees, whether or not they’ve disclosed that information, it’s time to ask if your practice aligns with their needs. Here are some ways to create a neuroinclusive work environment: Personalization and Flexibility: Provide quiet spaces or remote work options to accommodate sensory needs and preferences.

Offer various meeting styles, such as walking meetings or cameras-off options, to accommodate diverse communication needs.

Open Communication and Normalization of Difference: Encourage open discussions about

22

THE VISIONARY

neurodivergence to reduce stigma.

Focus on strengths rather than challenges in conversations.

Connection and Understanding: Build authentic relationships and personalized support that reflects a true understanding of your team.

Foster a sense of community and peer support.

Collaboration and Equality: Create a collaborative atmosphere that flattens power differentials.

Promote a culture of openness, flexibility, and authenticity.

Reducing Overload: Simplify processes, such as reducing unnecessary emails, to prevent overwhelm.

These strategies underscore the importance of creating work environments that are inclusive, flexible, and tailored to meet diverse needs.

By prioritizing openness, personalization, and understanding, workplaces can become more supportive and effective for everyone.

www.thegrouppraticeexchange.com

Issue 4

To truly transform the workplaces we lead, we must start by transforming ourselves. This involves deconstructing our unconscious biases about not just disability, but also gender, race, queerness and so many other marginalized identities, allowing us to truly hear and understand our people’s needs.

A neuroinclusive workplace requires shifting from rigid expectations to a culture of curiosity and compassion, where every brain and body is valued, not just theoretically, but in the everyday practices of our workplaces.

Lead with empathy, challenge the status quo, and commit to a vision of inclusivity that empowers every individual to thrive—not in spite of their differences, but because of them.

1. https://teamstage.io/job-satisfaction-statistics/ 2. https://teamstage.io/job-satisfaction-statistics/ 3. https://teamstage.io/job-satisfaction-statistics/ 4. https://teamstage.io/job-satisfaction-statistics/ 5. https://neurolaunch.com/adhd-strengths-in-theworkplace/ 6. https://neurolaunch.com/benefits-of-autism-in-theworkplace/ 7. https://www.sciencedaily.com/releases/2018/04/18 0417130111.htm 8. https://www.spill.chat/mental-healthstatistics/workplace-mental-health-statistics

23

Need more support? Join The Exchange.

The Exchange is a monthly membership program made specifically for group practice owners who want to independently explore 100s of resources at your own pace. It’s a business development resource dedicated to group practice ownership and leadership.

It’s meant to be your reference, your guide, your training hub and your place for connection with other group practice owners.

What do you get?

Monthly training sessions with Maureen and other experts who help group practice owners grow and scale their businesses.

Podcast coaching opportunities.

Monthly Q+A/Office Hours with Maureen Monthly finance/HR/HIPAA/Integrator roundtable Q+A A growing resource library full of useful training videos, interviews and coaching session recordings, and more!

70+ editable docs, including contracts, offer letters, client-facing and staff-facing documents, and business docs.

Bonus: Peer led Facebook community

METRICS TO TRACK

In Your Group Practice

Admin Metrics Calls → scheduled → attended 1st session (Call logs + Intake average) Med management metrics - (Calls → scheduled → attended) Demographics by location Reason clients don’t schedule initial appointments Method of payment/insurance for inquiries Referral sources New client feedback form Clinician retention after 3rd session Telehealth vs. in-person scheduling Daytime vs. evening appointment scheduling per month Availability preference for potential clients EAP usage

Clinical Metrics Clinician hour tracking Time off tracking Office space capacity/utilization per location Retention/attrition Clinician caseloads + session average payments Note completion stats

Onboarding Metrics 90-day weekly review Clinician info sheet (this sheet would include whether they're salaried or not, start date, and demographics) Recruiting referral source and outcome New hires per month (this sheet would include a tab to track # of hires, interviews, and demographics) How applicants find us Recruiting pipeline Hiring status of applicants

HR Metrics HR requirements (renewals, etc.)

Exit Interviews Quarterly retention Employee benefits Client retention Team member training tracking Benefits costs to the employer Employees not/using benefits

Financial Metrics Cash reserves Profit Overhead Payroll costs AR

Issue 4

THE VISIONARY

Teletherapy Regulations PostPandemic: Navigating the Changing Landscape By: Maureen Werrbach, LCPC

The pandemic dramatically reshaped the landscape of mental health care, with teletherapy becoming a lifeline for both therapists and clients.

However, as the pandemic subsides, the regulatory environment is shifting once again. Group practice owners must stay up-to-date with the latest changes to ensure compliance while maximizing the potential of telehealth services. Here’s a breakdown of what practice owners need to know about post-pandemic teletherapy regulations and how these changes impact their businesses.

In 2020, restrictions around telehealth were relaxed to ensure access to mental health services during lockdowns and periods of isolation.

Teletherapy became widely accepted by clients, and its usage surged. Clients benefited from easier access to therapists, particularly those in rural or underserved areas. Mental health professionals, meanwhile, discovered new flexibility in their work schedules and locations.

The temporary suspension of many regulations allowed therapists to provide services across state lines, and insurance companies offered broader coverage for telehealth sessions. This combination made teletherapy not only viable but often the preferred mode of care for millions. But, good things, for clients and therapists alike, come to an end when it comes to the pocketbooks of insurance companies.

State Licensing Requirements: During the pandemic, some states allowed out-of-state practitioners to provide teletherapy services without additional licensing. Post-pandemic, many states are returning to their pre-pandemic regulations, requiring therapists to be licensed in the state where the client resides. This change could severely limit access to care for clients in rural areas or states with fewer mental health providers. Compacts have started pushing harder for national licensing to combat this to allow for greater access and less gatekeeping.

www.thegrouppraticeexchange.com

26

overwhelm happens.

Jeff fancied himself a great entrepreneur.

But his current situation forced him to reconsider his beliefs.

Issue 4

THE VISIONARY

Insurance Coverage: Insurers broadly embraced teletherapy during the pandemic, reimbursing it at the same rates as in-person care. However, many insurers are starting to roll back these policies, reducing reimbursements or limiting the types of teletherapy services they cover.

Group practice owners will need to closely monitor their insurance contracts and advocate for maintaining equitable coverage for teletherapy services .

HIPAA Compliance: During the pandemic, some HIPAA regulations were relaxed to allow for the use of non-HIPAA-compliant platforms like Zoom or Skype for teletherapy.

As regulations tighten again, practices need to ensure they are using HIPAA-compliant platforms to avoid penalties and protect client confidentiality .

The Impact on Clients: While some clients have embraced the return to in-person therapy, many still prefer the convenience of teletherapy. Post-pandemic, clients may face barriers if their insurance no longer covers teletherapy or if their therapist can’t provide services due to licensing restrictions.

Available Compacts Professionals

for

Mental

Health

Licensure compacts are becoming a key solution for mental health professionals, enabling them to provide teletherapy across state lines more easily. Here are the current compacts relevant to group practice owners: • PSYPACT (Psychology Interjurisdictional Compact): PSYPACT allows licensed psychologists to provide telepsychology and temporary in-person services across state lines.

As of September 2024, 42 states participate in

www.thegrouppraticeexchange.com

PSYPACT, making it easier for psychologists to reach clients outside their home state. This is the only active compact currently.

• Counseling Compact: For licensed professional counselors (LPCs), this compact enables cross-state practice. 37 states have enacted this compact, and applications for multistate licensure are expected to open by mid-2024.

• Social Work Licensure Compact: This compact has been enacted in 22 states but is still in its early stages. Social workers are expected to be able to apply for multistate licenses in late 2025 .

• Marriage and Family Therapy: Unfortunately, no formal compact currently exists for marriage and family therapists (MFTs). Advocacy is underway for licensure portability models, but these are still in development.

Ongoing Federal and State Regulatory Changes Affecting Teletherapy While teletherapy became a staple during the COVID-19 pandemic, many of the temporary regulatory changes and flexibilities are now being re-evaluated by federal and state lawmakers. These decisions will have significant implications for group practice owners who want to continue offering teletherapy.

Medicare’s Changing Telehealth Reimbursement Policies Medicare expanded its coverage of telehealth services during the pandemic, allowing a broader range of services and provider types, including licensed clinical social workers, to be reimbursed at the same rate as in-person services. However, many of these flexibilities are set to expire at the end of 2024, unless further legislation extends them. For example:

27

THE VISIONARY

Telehealth Flexibility Waivers: The Consolidated Appropriations Act of 2023 extended some telehealth flexibilities, such as allowing patients to receive telehealth in their homes and removing geographic restrictions for behavioral health services.

Proposed Cuts to Reimbursement Rates: The 2025 Physician Fee Schedule proposed by the Centers for Medicare & Medicaid Services (CMS) includes a 2.8% reduction in reimbursement rates, which could make it less financially viable for practices to offer telehealth.

These shifts could limit the ability of group practices to offer teletherapy at affordable rates for Medicare patients, especially in rural or underserved areas.

Medicaid and State-Specific Telehealth Laws Medicaid policies regarding telehealth vary widely by state. Many states expanded telehealth coverage during the pandemic, particularly for behavioral health services.

However, as the public health emergency has ended, some states are rolling back these expansions. Group practice owners need to stay updated on their state’s Medicaid policies to understand how telehealth services will be reimbursed moving forward.

Private Insurance and Parity Laws Currently, 43 states, Washington D.C., and the U.S. Virgin Islands have laws that require private insurers to cover telehealth services, often at parity with in-person care. However, enforcement of these laws and the specific services covered can vary. Some states are beginning to limit the scope of telehealth coverage and lowering reimbursement rates as pandemic-related flexibilities are withdrawn.

www.thegrouppraticeexchange.com

Issue 4

The Future of Teletherapy Teletherapy is here to stay, but the postpandemic world will require adaptation. Some states are exploring licensure compacts, which would allow therapists licensed in one state to provide services in multiple states without the need for additional licenses. These compacts are already benefiting psychologists, counselors, and social workers in many states, and may eventually extend to more professions. It’s on us as providers to advocate for our states to join these compacts. Talk to local representatives in your state about how they are working towards joining your license compact.

Steps Group Practice Owners Should Take To navigate these changes successfully, group practice owners should: Review Licensing Laws: Stay updated on the licensing requirements in the states where your clients are located. Consider joining teletherapy licensing compacts if available.

Monitor Insurance Policies: Regularly review your contracts with insurance providers to ensure teletherapy services are still covered. Advocate for equitable telehealth reimbursement rates.

Ensure HIPAA Compliance: Double-check that the platforms you’re using for teletherapy sessions are HIPAA-compliant, especially as temporary allowances come to an end.

Embrace Hybrid Models: Create a flexible practice model that accommodates both teletherapy and in-person care, allowing you to meet client preferences while staying compliant with new regulations.

Advocate: Engage in local and state mental health advocacy. I’ve seen myself the

28

Issue 4

THE VISIONARY

power of connecting with local representatives has had on changing laws that support our profession and our clients. Power is in the collective.

Teletherapy offered a critical solution during the pandemic, and while regulations are tightening, its place in mental health care is secure. By staying informed about licensing, insurance, and HIPAA requirements, and utilizing professional compacts where possible, group practice owners can continue to offer flexible and accessible care to their clients. As teletherapy becomes a permanent fixture, practices that adapt will thrive in the new regulatory landscape.

Resources: https://www.gethealthie.com/blog/telehealth-regulationsby-state https://www.cchpca.org/resources/telehealth-policyacross-us-2024/ https://www.csuitewellness.org/blog/navigating-mentalhealth-compacts https://www.counselinginstitute.org/news/2024counseling-compact-what-therapists-should-know https://swcompact.org/2024/ https://www.medlawblog.com/2024/07/articles/medicarereimbursement/medicare-proposed-2025-telehealthchanges/ https://www.cms.gov/files/document/mln901705telehealth-services.pdf https://chghealthcare.com/blog/telehealth-rulesregulations

The Mental Health Workforce Shortage:

Solutions for Group Practice Owners BY: MAUREEN WERRBACH, LCPC

The mental health industry is currently facing an unprecedented workforce shortage. As the demand for mental health services continues to grow, group practice owners are struggling to keep up with the influx of patients.

This shortage is affecting not only access to care but also the quality of services provided. For group practice owners, the challenge is finding solutions to retain staff, fill open caseloads, and continue delivering quality care to their clients.

The Scope of the Problem The mental health workforce shortage has been building for years, but the pandemic significantly exacerbated the issue.

As of 2024, more than 160 million Americans live in areas with mental health professional shortages, with over 8,000 additional professionals needed to meet demand, with an estimated 30,000 provider shortage by the end of 2025.

www.thegrouppraticeexchange.com

29

THE VISIONARY

Contributing factors include: Increased demand for services: The COVID-19 pandemic triggered a surge in mental health issues. This surge led to an overwhelming demand for services, far outpacing the availability of mental health professionals.

Burnout among providers: Many mental health professionals are experiencing burnout due to increased workloads, exacerbated by the emotional toll of treating patients during a global crisis.

Limited educational pathways: While the demand for mental health professionals is growing, the number of graduates entering the field is not keeping pace, partly due to limited capacity in educational programs and challenges in obtaining clinical training.

More solo and group practices: Since the pandemic, it’s become easier to start a solo practice, and it has impacted visibility for individual and group practices.

Strategies for Group Practice Owners to Address the Shortage Prioritize Staff Retention and Well-Being With burnout being a significant factor in the workforce shortage, it is essential for group practice owners to focus on retaining their current staff by creating a supportive work environment. Here are a few ways to prioritize employee well-being: Flexible Work Arrangements: Offering teletherapy options, hybrid work models, or flexible hours can help reduce burnout and increase job satisfaction.

Wellness Programs: Implementing employee wellness initiatives such as mindfulness sessions, peer support groups,

www.thegrouppraticeexchange.com

Issue 4

or stress management workshops can help mitigate the emotional toll of the job.

Manageable Caseloads: Encourage sustainable caseloads to prevent overworking your staff and provide mental health days to encourage recovery from the emotional strain of the job.

Ask for Feedback: Asking your team for feedback on what they need to feel supported and making adjustments as able.

Leverage Telehealth and Technology Telehealth can help alleviate some of the pressures created by the workforce shortage.

With many states relaxing regulations around telehealth, group practices can hire remote workers from other states, expanding their talent pool beyond geographic constraints.

Utilizing Teletherapy: Expanding teletherapy services allows practices to serve more clients while providing flexible working conditions for therapists.

Leveraging telehealth technologies can also reduce overhead costs for the practice, if done effectively.

Automating Administrative Tasks: Implementing practice management software can streamline billing, scheduling, and client communications, reducing the administrative burden on therapists and allowing them to focus on patient care.

Expand Your Talent Pipeline One long-term solution to the workforce shortage is to cultivate a pipeline of future mental health professionals. Group practice owners can engage with local universities and training programs to create internship and residency opportunities.

Supervision for Interns: By offering clinical supervision to counseling interns and social work students, group practices can create a

30

Issue 4

THE VISIONARY

pipeline of new talent while fulfilling a critical need for training opportunities.

Partnerships with Educational Institutions: Establishing partnerships with universities can help you tap into a pool of emerging talent, while also offering hands-on experience to students and interns in a realworld setting.

Diversifying Your Recruiting Pipeline: Research additional methods for attracting qualified clinicians outside of the usual suspects (ie. LinkedIn and Indeed). They’re oversaturated and everyone is looking there. Get creative and try new recruiting methods.

Consider Alternative Staffing Models Innovative staffing models can help ease the strain caused by the workforce shortage. For example: Hiring Licensed Therapists from Other States: The use of licensure compacts like PSYPACT (for psychologists) and the Counseling Compact (for LPCs) can allow practices to hire professionals licensed in other states to provide teletherapy. Check legal and state specific laws first.

Leveraging Peer Support Specialists: Peer support specialists can complement traditional therapy services, providing clients with additional support while alleviating some of the demand on licensed clinicians. Currently, 39 states allow Medicaid reimbursement for peer support specialists.

Holistic services: Focusing on the whole person, other provider types may give you more options for staffing, and help your current clients.

Government and Industry Address the Shortage

Interventions

www.thegrouppraticeexchange.com

to

Loan Repayment and Scholarships The National Health Service Corps offers loan repayment and scholarships to mental health professionals who agree to serve in underserved areas. As of 2024, over 80% of professionals who participated in these programs from 2012 to 2020 have continued practicing in underserved areas.

Federal Funding for Training Programs In 2024, the Bipartisan Senate Bill allocated funds to increase the number of mental health professionals trained in rural areas, including adding 400 new psychiatric residency slots to Medicare’s Graduate Medical Education program.

Medicaid Expansion for Peer Support Specialists In response to the workforce shortage, 39 states now reimburse peer support specialists through Medicaid. This has helped expand access to care while supporting the mental health workforce. However, training and certification standards vary between states, which can limit the effectiveness of this program.

Advocacy for Reimbursement Rates Low reimbursement rates for Medicaid, Medicare, and private health insurance companies continue to hinder the ability of mental health professionals to accept new clients under these programs. Efforts are ongoing to raise reimbursement rates, making the field more financially viable for providers.

The mental health workforce shortage presents a significant challenge for group practice owners, but by focusing on retention, leveraging technology, expanding the talent pipeline, and considering innovative staffing

31

Issue 4

THE VISIONARY

models, practices can mitigate the impact.

Collaboration with educational institutions, government, and industry is also key to developing long-term solutions.

Group practice owners who adapt to these strategies will be better positioned to navigate the workforce shortage while continuing to provide essential mental health services.

Resources: https://www.gao.gov/products/gao-23-105250 https://bhw.hrsa.gov/sites/default/files/bureau-healthworkforce/Behavioral-Health-Workforce-Brief-2023.pdf https://www.commonwealthfund.org/publications/explain er/2023/may/understanding-us-behavioral-healthworkforce-shortage https://www.ncsl.org/labor-and-employment/behavioralhealth-workforce-shortages-and-state-resource-systems

Mental Health Legislation and Insurance Coverage:

Navigating the Evolving Landscape for Group Practices BY: MAUREEN WERRBACH, LCPC

Legislative changes and insurance policies are evolving rapidly in the mental health world. Part of our visionary work as group practice owners is to stay informed about the latest developments in mental health legislation and insurance coverage to ensure that their practices remain compliant and financially sustainable. In this article, we’ll explore recent changes in mental health laws, the impact of insurance reforms, and how group practice owners can engage in advocacy to improve mental health access and reimbursement.

The Mental Health Parity and Addiction Equity Act (MHPAEA) One of the most significant legislative milestones for mental health coverage in the U.S. is the Mental Health Parity and Addiction Equity Act (MHPAEA), passed in 2008. This law mandates that insurance coverage for mental health and substance use disorders must be equal to coverage for physical health conditions. Despite the law, enforcement and compliance issues persist, leaving many patients struggling to access the care they need due to high out-ofpocket costs and limited provider networks. Recent updates to the MHPAEA have focused on improving enforcement

www.thegrouppraticeexchange.com

32

THE VISIONARY

and requiring insurance companies to provide more transparent information on how they cover mental health services.

Medicaid Expansion and Its Impact on Mental Health Coverage Medicaid remains the largest payer of mental health services in the U.S., but coverage policies vary by state. Medicaid expansion under the Affordable Care Act (ACA) allowed millions more Americans to access mental health services, particularly in states that opted into expansion. However, in states that have not expanded Medicaid, access to mental health services remains limited, creating significant disparities in care.

Medicare Coverage for Mental Health Services Medicare is a critical payer for mental health services for individuals aged 65 and older, as well as for younger adults with disabilities.

While Medicare offers coverage for services like psychotherapy, psychiatric evaluations, and medication management, it has long excluded marriage and family therapists (MFTs) and licensed professional counselors (LPCs) from reimbursement. However, starting in 2024, new legislation will expand Medicare to include these professionals, which will greatly increase access to mental health services for the aging population.

Despite these advances, reimbursement rates for mental health services under Medicare remain relatively low, which can discourage providers from accepting Medicare patients.

Group practices must weigh the financial implications of accepting Medicare clients while ensuring access to care for this underserved population.

Insurance Reimbursement and Parity Laws

www.thegrouppraticeexchange.com

Issue 4

In addition to federal laws like MHPAEA, many states have enacted their own insurance parity laws, requiring private insurers to cover mental health services at the same level as physical health services. Currently, 43 states have parity laws in place, but enforcement varies widely. Some states have begun auditing insurance companies to ensure compliance, which could lead to increased coverage for mental health services.

For group practices, understanding the nuances of these laws is critical. Practices must work with insurance providers to ensure they are reimbursed fairly for the services they offer. This may involve negotiating rates, auditing payment structures, and advocating for better coverage with both state regulators and insurance companies.

The Future of Telehealth Coverage One of the most significant changes in mental health service delivery since the pandemic has been the rise of telehealth. Federal and state governments expanded telehealth coverage dramatically during the pandemic, making it easier for providers to offer services remotely.

However, as pandemic-related waivers expire, telehealth coverage is being rolled back in some states. The Consolidated Appropriations Act of 2023 extended certain Medicare telehealth flexibilities through 2024, but private insurers and Medicaid programs are beginning to limit telehealth services.

For group practice owners, navigating the evolving landscape of telehealth coverage is crucial. Some insurers may require in-person visits after a set period, while others may impose stricter reimbursement guidelines for teletherapy services. Staying up-to-date on these changes will allow practices to offer

33

Issue 4

THE VISIONARY

flexible care options financial sustainability.

while

maintaining

Engaging in Advocacy to Improve Access and Reimbursement Group practice owners can play a key role in shaping mental health policy by engaging in advocacy at the local, state, and national levels. Here are several actionable steps group practices can take to advocate for improved telehealth access, mental health parity, and reimbursement: Form or Join Local Coalitions: Collaborating with other mental health providers amplifies advocacy efforts. For example, in my state of Illinois, coalitions of mental health professionals successfully lobbied for increased telehealth access during the pandemic. Group practices can join local chapters of the NASW or APA or ACA to collaborate on advocacy initiatives.

Engage with State Legislators: Group practice owners should reach out to their state legislators to discuss mental health reimbursement and telehealth policies. In Virginia, advocates successfully pushed for legislation to expand telehealth services and increase Medicaid reimbursement. In Illinois, group practice owners band together with local representatives to put into law coverage for first responders, which previously was limited by our city workers insurance policy. Meeting with legislators, sharing data on how current policies affect patient care, and supporting relevant bills are effective ways to advocate for change. Find local state representatives who advocate for mental health and connect with them. They need you!

Nationa l Advocacy through Professional

www.thegrouppraticeexchange.com

Associations: On a national level, joining organizations like the American Counseling Association (ACA) or American Telemedicine Association (ATA) can amplify advocacy efforts.

These organizations regularly organize advocacy days and campaigns to influence federal policies like Medicare reimbursement and telehealth access.

Leverage Media and Social Media for Advocacy: Writing opinion pieces or using social media to discuss the challenges group practices face can bring public attention to key issues. Social media campaigns helped mental health advocates during the pandemic push for continued telehealth reimbursement. Your voice matters and local news outlets are always looking for ways to expose unfair policy.

Partner with Policy Advocacy Groups: Partnering with groups like NAMI can provide resources and support for advocacy efforts.

These groups often provide training, organize campaigns, and help connect mental health providers with lawmakers.

The landscape of mental health legislation and insurance coverage is continually evolving, creating both challenges and opportunities for group practice owners. By staying informed about key legislative changes, engaging in advocacy, and working with insurance providers to ensure fair reimbursement, practices can continue to provide high-quality care to their clients while shaping the future of mental health services. https://chghealthcare.com/blog/telehealth-rulesregulations https://www.cchpca.org/resources/telehealth-policyacross-us-2024/ https://telehealth.hhs.gov/providers/telehealth-policy

34

RED FLAGS DURING INTERVIEWING AND ONBOARDING Lack of hungry, humble, smart Humble team members are quick to point out the contributions of others and slow to seek attention for their own. They share credit, emphasize team over self and define success collectively rather than individually. Hungry team members are self-motivated and diligent. They are constantly thinking about the next step and the next opportunity. Smart team members are interpersonally appropriate and aware. They have good judgment and intuition around the subtleties of group dynamics and the impact of their words and actions.

Entitlement Expecting more than what's been communicated (outside of reason) Questioning business policies or procedures Attitude towards company, leadership, colleagues Badmouthing former employers

Lack of alignment Doesn't know anything about your practice Speaks in generalizations about why they want to work for you Doesn't know about your M/V/V Isn't a "hell yes" about your M/V/V

Accountability Issues Not able to take accountability-blames things/others Not able to set and honor boundaries Messages after hours or overly communicative Schedules appointments outside of office hours Blocks their calendar or changes their agreements after hire

Disinterested or Difficult Lack of passion for facilitating change Responding inauthentically during interview-answering how you want them to vs. genuinely Lack of thoughtful questions during the interview and onboarding Not asking about workplace culture "I'll do whatever" or vague responses Being overly picky about who theyll work with

CLIENT RELATIONSHIP MANAGEMENT & MORE

Streamline Your Practice with Admirra Your spreadsheet nightmares are over.

Pre-Built Client Intake Forms and Communication Features

Match Clients to Practitioners in Minutes

Built-In Insurance Verification

Understand and Improve Your Practice with Data Analytics

Optimize your operations with Admirra – so you can focus on client care!

Protect Your Data with HIPAA Compliant Features and Integrations

No IT Expertise or Installation Necessary

“As an owner of a group practice for the past 13 years we have tried all different systems and efforts to organize the Intake Process with many complicated steps. Admirra resolves all of these challenges and more by streamlining client referral and assignment process, insurance eligibility, and tracking analytics. It is truly such a valuable tool!”

- Mollie Busino Founder/Director of Mindful Power, LLC

Unlock Your Free Trial Today! info@admirra.com

Admirra.com

INCREASING

PASSIVE INCOME

THROUGH SELF PUBLISHING Have you ever created worksheets or journal prompts for your clients? Do you want to start a low investment passive income stream? Then selfpublishing on Amazon can be a low stakes and very beneficial tool for you clients and for marketing to future clients.

During consultations with potential new clients, what I hear most often when I ask about previous therapy experiences is that they enjoyed getting to have someone to talk to, but they wanted more direction, guidance, and skills to practice outside of session. With the ease of access to tech fueled online therapy platforms and a generation receiving most of their therapy from social media, therapists need to adapt and provide more their therapy experience. There has been a large increase in demand for self-help tools such as journals, workbooks, and card decks over the past few years. It may feel daunting to start one of these projects or that you need a huge social media following to justify the cost and the time, but it might be more accessible than you think!

I remember when I first started thinking about selfpublishing a workbook that it would be a huge undertaking and that I didn’t have enough material or enough to say to even justify putting my time towards a project like this. Then I purchased a couple workbooks and journals that were selfpublished by therapists and coaches and realized that maybe this isn’t as overwhelming as I thought!

Dr. Brittany Woolford, Ph.D. Owner and Psychologist Lone Wolf Psychological Services

First, you need to think about your population and your niche. What topics are your clients struggling with and how much work and time are they willing to put into self-improvement.Even if we think we should provide an abundance of content for them, keep your population in mind and what amount of

THE VISIONARY

content will keep their attention. Then, think of what you already have created.

Have you created worksheets, mediations, journal prompts, blog series, or well received social media content?

Utilize content you have already created or thought about for your client base.

From there you can decide if you want to create a book, journal, or workbook format.

There are multiple platforms out there to self-publish, I chose Amazon Kindle Direct Publishing (KDP) because of its low cost for printing, and it directly publishes to Amazon, so you can easily direct clients to Amazon to purchase. KDP has a platform where it will help you create and format your finished project. Formatting your product is one of the more difficult tasks, and I spent several angry nights cursing my computer, but there are helpful guides and videos to walk you through the process. For cover art and any art in your project you can decide your level of effort and need. This wasn’t a high priority to me, so I just used Canva to create a simple cover.

To determine how much to charge for your project you can do market research on Amazon and determine what others are currently charging for a similar item.

KDP will allow you to set any price you want for your project. After you set your price, KDP will then tell you how much of a royalty you will receive for copies purchased on Amazon. You will be able to see on your KDP platform how many copies are sold, and you will periodically receive a direct deposit of your royalties.

www.thegrouppraticeexchange.com

Issue 4

After you have completed and formatted your project on KDP, you will order a draft copy (very minimal cost) to make sure everything looks and is formatted the way you want. From there you can order author copies in bulk (the journals I created cost from $3-$5 a copy) to have for yourself and in a few weeks your project will be available to purchase directly on Amazon. You’ll get a nice buzz telling clients, co-workers, and friends that you are published on Amazon, and it helps build your credibility with your niche base!

How you can utilize and market these tools: Purchase author copies and use as marketing tools: Your finished project is a minimal cost to print, so it makes for a great marketing tool. Purchase a large amount in bulk and give them out at places where your target client spends time. For example, I have a premarital workbook, so I went to bridal shops and wedding venues and handed out several copies. Having something physical that you published is a much better marketing tool than just a business card!

Give them to some clients for free: Again, since it is fairly cheap to print, utilizing these in session can be a great way to increase client retention.

It gives your client something to work on outside of session and increases your credibility. I have had multiple instances of clients purchasing my workbooks to give to their friends or family after I gave them a free copy.

Email marketing to current clients:

37

THE VISIONARY

Send an email to all your current clients letting them know about your recently published work. This can lead to them purchasing it for themselves or buying it to share with others!

Market on your website as a self-help tool: Sometimes when people call in for services, they aren’t quite ready for therapy or for the investment of therapy.

Having your published project on your website as an option gives a middle ground for a new client to engage with you and see if your expertise would be valuable for a minimal investment cost on their end.

This is also a great tool if you have a waitlist, so you can give the client something to work on prior to starting therapy with you and keep them engaged!

Market on your social media: You don’t need a large social media presence to market your finished project. If you are spending any time on your social media, it is important to have a product for your followers to purchase! Your followers may not want to start therapy or live in a state that you are not licensed, so having a low-cost product that they can try out is a great way to increase engagement and provide income for the work you are putting into your social media.

Issue 4

success and interesting ways they have marketed themselves.

A local matchmaker would frequently buy my dating journals in bulk to give to her clients, I had a therapist on social media utilize a journal and then buy it in bulk for her upcoming workshop, or I even had a practicum student who was working at my practice take it to her next site at a college counseling center where they bought multiple copies. You can make this a big project and emphasize the marketing to make it wildly successful, or you can make it a side project and utilize it for marketing and some passive income. Either way, it is easier than you think, and will help you keep current and adapt to the changing forefront of mental health!

Self-Publishing using KDP doesn’t have any upfront costs, and you never know where it will lead. This is truly passive income for myself, and I have spent hardly anytime marketing my journals and workbooks, but because they are good products and truly helpful, I’ve had

www.thegrouppraticeexchange.com

38

NEW BOOK LAUNCH!

GRAB YOUR COPY

THE VISIONARY WWW.THEGROUPPRACTICEEXCHANGE.COM