Insider’s Guide: How to Pay for Therapeutic Boarding School (2017 UPDATE)

Before we dive into understanding the options for paying for a Therapeutic Boarding School, let’s quickly review what they are.

The Rise of Therapeutic Boarding Schools

Image result for boarding schoolAs public schools across the country have slowly been pruned back by state legislatures, funding for behavioral, emotional and academic support within schools have nearly dried up while public money is increasingly being used for private charter schools. Therefore, it’s not surprising private institutions that offer therapeutic (or quasi-therapeutic) environments like boarding schools and private schools have exploded. One of the fastest growing kinds of boarding schools is what’s called a Therapeutic Boarding School. Therapeutic boarding schools maintain the advantages of traditional boarding schools such as intimate class sizes, individual attention, great academics, developing student self-reliance, and the fun of living with peers in a completely “child-friendly” environment.

Some therapeutic boarding schools specialize in helping teens overcome certain psychological problems such as Attention Deficit Disorder, Bipolar, Asperger’s and even Depression. Others have programs for overcoming substance abuse problems or achieving weight loss. Some specialize in helping students who lack motivation get a fresh start in a nurturing environment. Most have some sort of family or parent involvement piece to ensure a team approach (ie. Weekly family therapy via phone or Skype).

While this all may sound great, there are definitely some risks and downsides (beyond the financial cost) of sending a kiddo off to therapeutic boarding school. I address those issues in great detail in another blog post. For now, let’s revisit the financial aspects…

Expense or Investment?

Parents often find themselves in a desperate situation with a troubled teenager. Their daughter runs away from home again, gets caught with the dealer down the street, crashes another car, and has yet another arrest. Parents become afraid for their teen’s lives as their teen’s risk-taking and lifestyle keeps becoming more extreme as the parents’ ability to set boundaries and expectations seemingly erodes.

It’s hard to think clearly and find solutions at times like this. Therapeutic boarding schools and therapeutic wilderness programs can provide answers, but they come at a price, with some programs running upwards of $50,000 a year.

But cost doesn’t have to be an insurmountable obstacle in getting your teen the help they need. We have helped countless parents in similar situations come up with creative ways to finance therapeutic boarding school, knowing that their child desperately needs an intervention. Therapeutic boarding schools are no longer exclusively the domain of the wealthy.

Top 10 Ways to Pay for Therapeutic Boarding School

Image result for therapeutic boarding school

Here are 10 ways families just like yours found to finance their teen’s therapeutic program:

1.   Hire a Consultant: Say what? More money? Yes, but trust me, this really will have super high ROI. Also referred to as case managers, therapeutic placement consultants or educational consultants, a good one is worth their weight in gold (a bad one is expensive and makes bad treatment recommendations). Make sure they are UNAFFILIATED with any program and have the clinical expertise to help advise and guide your family through the whole process. Some clinical educational consultants that specialize are able to handle this. A great case manager will be able to create a treatment plan, explain the process for getting a comprehensive psychological evaluation, walk with you through the intake process, support you while your teen is in the therapeutic boarding school, and coordinate discharge planning to ensure a seamless transition back to home or college. The last piece is essential – making sure your teen has everything they need to succeed after they return. Great case managers also know how to secure reimbursement from insurance providers for teens that attend therapeutic boarding schools. There are definitely some tricks (eg. Hire a case manager that’s also a licensed professional counselor and much of their work could be paid for by insurance) and inside knowledge necessary to make this happen.

Typical cost: $95 – 350/hr (some charge a flat fee of several thousand). 

2. Find the Program’s Financial Aid Officer: The private school or wilderness program should have a financial aid officer who can advise you about how to finance your child’s education. You should ask this person what programs, loans, discounts, or financial aid the school offers. Find out exactly what is included in the tuition and board bills, and if there are additional expenses such as buying uniforms or paying special fees for sports.

Typical Cost: Nothing – programs provide this to try to entice you into signing up. Beware of anything that sounds too good to be true – verify any claims they make about coverage from insurance, student grants/scholarships or loans. 

3.  Public School Funding: You may qualify for a loan through a kindergarten through 12th grade educational loan program. These loans work the same way as college loans, in that you pay what you can while your child is enrolled in the private school, and pay the rest off later. The terms of some loans let you spread out payments over 10 or 20 years. Your credit history will be a factor in securing a loan. Your school’s financial aid officer should be able to help you find such a loan.

Typical Cost: Your sanity – they will drive you crazy with the bureaucracy and take loads of time during your work day since everything in public school shuts down by 3:30pm. 

4.  Discounts for Upfront Payment: Some schools offer discounts if you pay by the year, instead of by the month. The average student stays at a therapeutic boarding school for less than two years, and wilderness programs are even shorter. A good therapeutic placement consultant/educational consultant will save you thousands of dollars by negotiating these discounts.

Typical Cost: More money upfront but no other associated costs. 

5. Tap 529: Consider using your child’s college fund first. Think of the therapeutic program as a way to get your child back on the right path toward college. Without intervention, she won’t have the grades or motivation to get through college and use her fund.

Typical Cost: Make sure there are no withdrawal penalties for use for therapeutic boarding school. 

6. Put it On Plastic: When you enroll your child in these therapeutic programs, there will be upfront expenses such as processing fees and deposits. Some parents borrow these initial payments from credit cards, especially ones that offer “frequent flier” miles. This way their child is immediately enrolled. They use their free mileage for transportation to and from the school.

Typical Cost: Beware of high interest rates if you don’t pay off your balance in full. 

7. Angel Investing: Some parents borrow the necessary funds from employers or relatives, and pay them back after securing educational loans or home equity loans.

Typical Cost: If you go through a peer-to-peer or crowdfunding site like The Lending Club or Kickstarter, count on a 5% fee for total amount funded. 

8. Health Insurance Reimbursement: Your health insurance policy may cover part of the cost of a therapeutic program as a medical expense. When you hire a case manager, they will be able to tell you how to file the paperwork and what you need from the program to ensure a speedy reimbursement.

Typical Cost: Sanity… totally lost if your insurer are jerks that don’t reimburse when and how they should. You are attempting to pull money from their cold, dead hands. Expect a fight.

9. Consult Your CPA: Some expenses for therapeutic schools and wilderness programs can be deducted from your income tax return as medical expenses. If you own your own business, you likely have WAY more creative options for deducting medical expenses.

Typical Cost: $200/hr for a good CPA to walk you through if and how to deduct from taxes.

10. Tap Home Equity: Parents have taken out second mortgages or home equity loans and then deducted their interest payments on their income tax returns.

Typical Cost: Fees, closing costs total 2-6%. It also bumps the timeframe for paying off that home back several years.

11. Public School Funding: We lied – there turns out to be 11 ways to pay for therapeutic boarding school. Is your child enrolled in public special education classes because of problems like attention deficit disorder and learning disabilities? Does your child have an “Individual Education Plan” at a public school? Do you suspect your child has learning problems that the public school cannot address? In certain cases, public school districts have to reimburse parents for private school tuitions. The Supreme Court ruled on June 22, 2009, that an Oregon school district had to reimburse a family for private school costs because the child in question could not achieve a free and appropriate education within the district. The child had not been enrolled in special education classes but was diagnosed later with attention deficit disorder.

When it comes to what matters most parents are unstoppable in finding ways to get the services and support they need. Don’t let cost be the determining factor. If your teen needs help, speak with a case manager, your trusted CPA as well as a therapeutic boarding school you’re considering and work together to find a way to get your teen back on track.

Insider’s Guide: Getting Insurance to Pay for Residential Treatment

imagesThis is our second installment on how to get insurance to pay for residential treatment and therapeutic programs. Below is some great information to help you beat the insurance companies at their own game. Insurance companies count on your ignorance, laziness and distractibility to avoid paying for services they are legally obligated to cover. 

With the Affordable Healthcare Act and the Mental Health Parity Act in full swing it’s time to learn how to get the most out of the insurance you pay for. We’ve included some tricks, strategies and how-to’s to help you out. Though we’re focusing on Residential Treatment for our discussion here, this info is applicable to therapeutic programs like wilderness programs, therapeutic boarding schools and intensive outpatient programs.

Ok, let’s get started with some basics… 

What If I Need Additional Help?

First, read through everything below. These strategies are time consuming and require steady attention but they are not impossible. If you still don’t feel confident in holding your insurer accountable, contact us for a free consult and we’ll help you figure out how to move forward. 

What is the Insurance Company’s Criteria for Residential Treatment?

…Or more importantly, how does an insurer define residential treatment? Each insurer has their own definition but most have virtually identical criteria. For our purposes, residential treatment is defined as specialized mental, behavioral health or substance abuse treatment that occurs in a residential (overnight) treatment center where the provider is responsible for clinical service, safety, shelter, and food.

Licensure differs by state, but these facilities are typically designated either as residential, subacute, or intermediate care facilities and may occur in care systems that provide multiple levels of care. Residential treatment is 24 hours per day and often requires a minimum of one physician (or psychiatrist) visit per week in a facility based setting. 

What Specific Criteria Do They Look For?

Now, let’s drill down a bit more and look at some of the more common criteria requirements insurance companies are looking for when determining whether to pay for residential treatment to a struggling teen or young adult. 

  • Was there a sincere attempt to first use evidence-based outpatient therapy in the home community by a licensed professional before residential treatment was requested and outpatient therapy did not work? Basically, they want evidence that you tried outpatient therapy with weekly sessions (or more often) and because it was not effective, a more intensive level of care like residential treatment was justified.
  • Prior to admission, did you contact your health plan for list of in-network residential treatment options? More on this later – what to do if you can not find a good option.
  • Is there uncontrollable risk-taking to self or others or other dangerous behavior?
  • Has there been a documentable and rapid decrease in level of functioning in one or more life domains. Another way to describe it is a decline in functioning resulting in the ability to perform self-care. 
  • Is there a likelihood of no improvement in current environment (ie. home or college)
  • Is there a reasonable expectation that patient will improve in residential setting and be able to return to outpatient therapy for aftercare? 

How to Request this Higher Level of Care?

Now that you understand the criteria, let’s talk about how to actually request residential treatment. 

  • Write a letter strongly recommending admission to residential treatment 
  • Provide copies of assessments and testing performed by a licensed professional that indicate 1) a formal diagnosis and 2) specific recommendations that list residential treatment.
  • Explain how outpatient therapy has not been successful
  • Explain why current circumstances make it unlikely that patient will show improvement (ie. Improvement is not likely in home setting due to social stressors such as negative peers that sell drugs but remain in the environment)
  • Document unsafe, declining behaviors – show symptoms and behaviors that represent a decline from usual state and include either self-injurious or risk-taking behavior that cannot be managed outside of 24 hr care. Can your kid maintain abstinence outside of 24 hr care? 
  • Explain that the residential treatment program uses evidence-based clinical interventions.
  • Request the residential treatment program directly contact your insurer for pre-authorization. Pre-authorization is the insurance company’s way of giving formal permission to use a higher (and more expensive) level of care. Make sure to obtain the tracking number and verification of the call from the residential treatment program. If approved, obtain written authorization confirming admission approval.

After you send off your request, your insurer should should respond in 5 days. Don’t wait that long – call them every day to find out the status of your request. Yes, seriously – call every day. 

Accepted! Now Some Additional Insurance Mandates

The insurance company accepted your request (more below on what happens when they do not accept it) and a wave of relief comes over you planning for some quiet time once your kid is safely transitioned. But before you get too comfy, there are a few things you want to make sure the residential treatment program will do to ensure insurance covers as much as possible. It’s easier to ask these questions during the admissions process rather than at discharge. Here’s a list of what to look for or ask for:

  • A basic physical during admission (urine screening for drug facility)
  • Onsite nursing and 24hr access to med care
  • Multidisciplinary assessment (also called a Biopsychosocial Intake) performed within 72 hr of admission, including information obtained from patient’s previous providers (ie. therapist, primary care physician)
  • Individual therapy with a licensed therapist (ie. LPC, LCSW, LMFT) at least one time per week
  • Weekly meetings with doctor for medication management
  • Weekly family therapy
  • Discharge plan created one week after admission which acts as a set of exit criteria
  • Licensed in the state in which they are located. Some facilities are owned by huge companies in another state. Make sure they are credentialed and licensed.

Denied. Now on to The Appeal Process

Denials are just a way of life in the therapeutic treatment world but it’s certainly not the end. Here are some information on what to do when you experience a denial.

  • First Thing – Do not let the denial get you mad and do not attempt to use logic, common sense or science to understand why. Insurance is a business and their business model is take in money and pay for as little service as possible – period. 
  • If residential treatment is verbally denied, request written denial. They must deny in writing and often will send the residential treatment program as well as the insured person a copy. 
  • Do not just ignore the denial and send your kid off unless you are willing to pay out of pocket and work your tail off at discharge to get the insurer to pay for it.
  • How to appeal depends upon the reason for denial. The insurance company will likely list specific criteria either your kid or the residential treatment program did not meet.
  • If the insurer states that residential treatment is not a covered benefit but they offer  other mental/behavioral health benefits, they are required by law to pay. In Harlick v Blue Cross of California – On August 26, 2011 the court confirmed that California’s Mental Health Parity Act requires health plans to provide coverage of “all medically necessary treatment” for “severe mental illnesses” under “the same financial terms as those applied to physical illnesses,” and are obligated to pay for residential treatment for people with eating disorders even if the policy excludes residential treatment.

And It’s Still Denied – What Next?

If you submit an appeal with additional information and site the law but still are denied or hear nothing, you can request an independent review from your state’s regulatory body that oversees insurance compliance. It’s amazing how quickly insurance companies can ‘find missing paperwork’ or reverse a denial when regulators and attorney’s get involved. 

  • Send a certified-mail cover letter describing the dispute
  • Provide all relevant evaluations, assessments and testing you already sent to the insurer
  • Submit a doctor’s letter stating care is medically necessary
  • You can also hire an attorney that specializes in insurance issues like this. They are often worth their specialist price tag.

Plan B – If You Can Afford It

If residential is denied and you don’t want to push the insurer for whatever reason, you can pay out of pocket for room and board and try to get the clinical services covered. This approach is often what is equivalent to out-of-network coverage. The insurer is more likely to cover outpatient therapy, group therapy and medication management (virtually the same as if client was living at home and going to therapy).

You can also request that the residential treatment primary therapist get a single case agreement which forces the insurer to pay at in-network rate and you only owe the copay, as usual. 

What if Our Family Member is at Therapeutic Boarding School?

With the growth of therapeutic boarding schools, we’ve received a ton of questions about how insurance pays for the clinical aspects of these hybrid programs. Here are some tricks we’ve picked up over the years:

  • Think like the insurance company – they want to hear your son or daughter is being referred to as a patient and not a student.
  • Make sure to request a physical assessment is done at admissions. This promotes the perspective that he/she is a patient and not a student. Remember – we want the insurer to understand this is a therapeutic program, not as much an academic program.
  • We also want to ensure the program is keeping daily records such as treatment plan updates, nursing and medical notes and service notes – health plans will want copies. We want to be documenting progress as well as setbacks. 

When we conduct placement services, we always request the therapeutic program develop a treatment plan with some specific exit criteria. The first day of treatment is the first day of discharge planning. Some plans will want exit criteria so err on the side of having the program provide it early on. It’s also a good clinical practice to give the providers a clear target. 

In Which State Should Insurance Regulators Be Notified if Insurance Refuses to Cooperate?

The state in which treatment is being provided is where insurance regulators should be contacted if your insurance company refuses to play nicely. The state in which you live may be where your insurance is attached, but legal oversight for provision of service and insurance regulation is in the treatment state. 

Can Insurance Pay for Services Retroactively?

Theoretically, yes. Practically, it’s pretty difficult and will require regular attention and contact with the insurer. They will likely ‘lose’ applications, claim forms and anything else you send. If you get insurance to agree to pay for residential treatment or other therapeutic services after treatment has started, you can request for retroactive coverage. It’s best to write a letter (and send it certified mail and keep a copy for your records) stating why you didn’t understand or it was not stated clearly in a policy that treatment was covered. 

Will Insurance Cover Partial Hospitalization Programs (PHP)?

Partial Hospitalization Programs or PHPs is typically a level of care designed for individuals who need structured mental health, behavioral health or substance abuse programming but do not need 24-hour supervision (ie. inpatient or hosplitalization). Many hospitals and residential treatment programs offer partial hospitalization or day treatment services. Good PHPs are designed to provide support, education, medical monitoring and accountability during the hours of the day often identified as most troublesome for patients. Patients participate in therapeutic groups, structured activities and discharge planning similar to those offered in the inpatient and residential programs. Many patients who have been in an inpatient or residential program can “step down” to this level of care because it continues to provide a high amount of structure and support. 

Insurance generally covers PHP at a per diem rate (daily rate) but will not cover overnight which the hospital or treatment program may charge extra for. Make sure to clearly understand how the treatment center charges for PHP before signing up. Also make sure insurance covers it and what portion it covers. 

So we covered several of the topics and tricks that can help you navigate the insurance company maze when it comes to paying for residential treatment. If you need additional help, contact us today – help@fonthillbehavioralhealth.com 

Getting Insurance to Pay for Residential Treatment

imagesSince paying for therapeutic treatments like residential treatment, intensive outpatient program and therapeutic boarding school with insurance is a big topic we’ve broken this into a few different posts. Today, we’re starting with the basics of the health care act that tightens up the requirements for insurers. Historically, insurance paid for outpatient services and residential treatment was only for more affluent families. But thanks to the mental health parity act, insurers are not more responsible than ever for paying for higher levels of care. 

What’s the Mental Health Parity Act?

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires many insurance plans that cover mental health or substance use disorders to pay for coverage for those services that are no more restrictive than the coverage for medical/surgical conditions. Basically, if they pay for medical stuff, they have to pay for mental health and substance abuse stuff – that’s the ‘parity’ part. 

What Does it Cover?

  • Copays, coinsurance, and out-of-pocket maximums
  • Limitations on services utilization, such as limits on the number of inpatient days or outpatient visits covered
  • Coverage for out-of-network providers
  • Criteria for medical necessity determinations

MHPAEA does not require insurance plans to offer coverage for mental illnesses or substance use disorders in general, or for any specific mental illness or substance use disorder. It also does not require plans to offer coverage for specific treatments or services for mental illness and substance use disorders. However, coverage that insurance plans do offer for mental and substance use disorders must be provided at parity (the same) with coverage for medical/surgical health conditions.

The original MHPAEA was enacted in October of 2008. The main purpose of MHPAEA was to fill the loopholes left by the previous Mental Health Parity Act was legislation signed into law on September 26, 1996 that requires that annual or lifetime dollar limits on mental health benefits be no lower than any such dollar limits for medical benefits offered by a group health plan.

What if My Plan is Not in Compliance?

Before escalating things and contacting state or federal officials, contact Fonthill to see how to ‘encourage’ the insurers to provide appropriate coverage (look for future blog posts on how to communicate and educate your insurers for coverage). If you still have concerns about your plan’s compliance with MHPAEA, you can contact the Feds or your State Department of Insurance. You can contact the Department of Labor at 1-866-444-3272 or http://www.dol.gov/ebsa/contactEBSA/consumerassistance.html. You can also contact the Department of HHS at 1-877-267-2323 ext 61565 or at phig@cms.hhs.gov or your State Department of Insurance at http://naic.org/.

Check back next time when we explore some tricks to getting insurance to pay for treatment – it’s what the insurance companies don’t want you to know. 

 

 

IECA Webinar: Working for Entitled, Demanding Families Part 1 of 2

On July 9, 2013 Fonthill Counseling Founder and Clinical Director Rob Danzman presented the IECA Webinar Working for Entitled, Demanding Families: Marketing, Customer Service, and Management Strategies. Below are some highlights from his presentation as well as responses to some great questions asked. The full presentation can be heard at at IECA Webinar Series.

1. Clients vs Customers

Focus on Customer Experience: How does you client experience your service from the first phone call or email all the way through till paying the final bill or discharge.

Entire Company is Part of Customer Service and Marketing: The entire company, whether it’s just you and your spouse or a dozen employees – everyone should be coached (…and trained) to act as a cohesive, comprehensive customer service and marketing team. Everyone should know their roles, goals and objectives.

Build Evangelists: Satisfied Families are more valuable than a sales team, advertising campaigns or even speaking gigs. When you satisfy the customer’s expectations, they leave happy. But when you EXCEED customer’s expectations, you turn them in to evangelists. Think about this…When was the last time anyone bragged about their recent Microsoft product? What about an Apple product? One company somewhat satisfies customers while the other generally exceeds expectations.
Reward Dedication with Desired Reinforcer rather than Assumed Reinforcer: Basically, find out what motivates customers. What they want more of and what they desperately want to avoid. This will provide insight into their behavior, goals, thoughts, and feelings. It also offers information on how to leverage customers when they get stuck.

2. Marketing

Connect to 5 Senses (…especially Music and Visuals): Memories, social connections and emotions are highly associated with our senses (ie. Song on the radio triggers flashback to highschool). Use this evidence-based approach on your website, literature and in your sessions to develop strong rapport and make great progress.
Make Them Feel Special (Special Access): Instead of talking about all the families you’ve served, focus on language that makes them feel like they are the only clients you have. Give them your direct cell number. Tell them to call you on weekends and evenings if they need anything. Go above and beyond with giving them access to you and your staff.
They Demand Immediate Response: Make sure to have an internal policy to respond to questions, concerns, and feedback within 24 hrs.
They Demand Quality Behind the Scenes (eg. Granite in Kitchen): When I go to tour therapeutic programs around the country, I insist on checking out the kitchens. Kitchens are great litmus tests for whether a program’s quality goes deep or is just superficial.
Differentiate with Niche, not Consensus: While you want to listen loudly to your customers’ needs, do not let it dictate your services and how you work. The Crysler Minivan was famously denied production when it was first conceived of by an engineer/designer. Crysler management said “No customer is asking us for anything bigger than a station wagon.” Customers don’t know what they really want until you give it to them.
Quality vs. Volume ( CHANEL vs. Old Spice): Similar to Niche vs. Consensus above, focus on a few things you can do really well. Don’t be all things to all people. Don’t focus on volume unless you plan on being the Wal-Mart of your industry.
Educate vs. Selling: Selling something involves pushing a product or service with the not-so-subtle goal of exchanging your goods for their money. Educating a customer involves ignoring the sale and focusing on their needs, wants, fears and goals. It’s a focus on finding congruent solutions between the customer and either something you can provide or someone else’s service. This develops a level of trust unparalleled between customer and professional.
Benefits vs. Price: Similar to above, focus on the benefits and attributes of your services and products rather than price. We rarely discuss price and rarely lower our price. Instead, we keep the conversation about matching the customer’s goals with what we offer.
Make it Exclusive: If everyone had access to purchasing BMW’s (ie. lower costs, cheaper product, etc.) they would not be coveted. Does anyone brag about being able to finally buy their dream Camry? Limit access to your service through pricing strategy, quality and limits to who you work with.
Next time…Check back for Part 2 when we go over Customer Needs vs Wants and Training Yourself and Staff

 

5 Things Your Education Consultant/Case Manager Should Be Doing Right Now

This is our raw, irreverent guide on what in our humble opinion education consultants and case managers should be doing right now to provide the highest quality service to you. This list is valid regardless of the type of mental, behavioral health or substance abuse treatment you or your loved one is receiving (eg. therapeutic wilderness program, therapeutic boarding school, individual outpatient therapy, psychological assessment). If you go through the list and your well-compensated professional is providing you with anything less than what we discuss below, copy and paste this into an email and let them know you’ll keep them hired only if they get on board.

1. Consistent Contact

When we first started Fonthill, we were so focused on accomplishing all the goals and objectives we developed with parents and families that we failed to keep everyone informed and on the same page. We learned from our mistakes that weekly contact (at a minimum) is essential. Your education consultant / case manager should be providing you (and the whole team) with regular email or text updates. These are not updates you should need to respond to, just information letting you know an application was submitted, insurance claim was accepted or that the psychologist doing your son’s assessment will be available about 30 minutes earlier if that works for you. Parents count on us to keep them informed.

2. Proactive Planning

Here is another mistake we made. Our teams are experts on working with behavioral acting out, crisis, intervention, parenting, and families but what we quickly learned we needed to do just as well was developing a treatment plan that included more than just what the parents thought was the issue. We expanded our planning WAY beyond what we estimated our involvement to be so that after we had worked ourselves out of a job (…another hallmark of good work) the family had a set of instructions, a road map, a guide if you will on who should be doing what and by when. Make sure that your education consultant / case manager is developing a plan that considers the big picture since treatment and life do not stop when the professional’s final payment is received. Seriously, they should be mapping out way far into the future to mitigate obstacles and pot-holes you are not even thinking of (eg. Financial literacy for your son entering substance abuse treatment).

3. Saying ‘No’

A really good way to determine if your education consultant / case manager is worth their weight in gold (…or Rhodium) is how often they say ‘no’ to 1. New Clients, 2. Current Clients and 3. Professionals on your team.

Let me explain. New clients – We make it very clear to perspective clients that not everyone that contacts us becomes a client. We could become the Wal-Mart of family services but quality would go WAY down. Education consulting, case management, family counseling and our parent education and consulting would become commodities. Many desperate professionals say ‘yes’ when leads are low and expenses are high (…McMansions are cheap ya know). Current clients – A really valuable and important education consultant and case manager is hired to set a course, develop a plan and make sure the heading if followed. Parents often, with the best intentions, attempt to deviate from the course when kids get unruly or their own fears start to percolate. Professionals – One of  our most important jobs as case managers is working out issues behind the scenes (eg. Setting a limit on the ‘add-ons’ a program may want to push on parents). Being able to effectively and respectfully say ‘no’ to other professionals is an essential skill that should be in your case manager’s repertoire.

4. Billing Fairly

Have you ever lost your mind when you looked over your hospital bill from the Cedars-Sinai Medical Center that showed that the Aspirin they gave you cost $1000? Yeah, we don’t like that either. We think billing should be fair and transparent. There are many, many families that we work with that make a bazillion dollars. There are also just as many families that are have very modest incomes. We charge the same for them all and we are upfront with our costs. We also don’t think it’s appropriate to gouge our clients with ridiculous initial consultation fees ($5,000 for an initial meeting? Get real.) We also don’t like contracts for X number of months. Life happens and we know families sometimes need to make drastic changes. Being on the hook for a service that’s supposed to solve problems and not create new ones is important to consider when signing up with an education consultant  or case manager. We recommend the shortest term necessary with flexibility built in. For instance, rather than expecting payment everytime we meet, we invoice clients monthly for the work completed (…not for the upcoming month like a landlord). Make sure you understand your bill and that all the expenses are for things you agreed to.

5. Maintaining Boundaries

Oh this one really gets us frustrated. To be able to have the healthiest working relationship with your education consultant and case manager they should constantly maintain professional boundaries similar to Licensed Professional Counselors – No dual roles (eg. Your professional is not also your CPA) and No merging of personal/professional relationships (eg. Your professional is not discussing non-work related issues). This may seem like small stuff but, think about it this way. You hired this person to provide objective analysis and recommendations to advance your family through some obstacle. This creates what in mental health parlance is referred to as a power differential. A power differential is when one party has greater power than the other (eg. Judge vs. defendant). In this case, the professional has power over the parents because the parents are in a vulnerable position, meaning they are counting on advice, but also relying on the professional to protect their confidential information, reputation as well as their emotional and psychological health. If your education consultant has crossed any line that’s not clearly stated in their scope of service, consider talking with them directly and asking them to respect the professional relationship you want with them by limiting the personal sharing and interaction. It may feel uncomfortable, but consider this – what happens if you are not happy with something they did? What happens if the treatment program they recommended turns out to be crap? It’s much easier to confront someone who has maintained professional boundaries throughout the process.

This list is not exhaustive but a starting point to ensure you have some reasonable expectations of what to expect in your relationship with an education consultant/case manager. Contact us at Fonthill if you need more help or if you’re not sure how to best use your current professional support.