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

 

Fonthill Response to Vice Article: AMERICAN TEENS ARE BEING TRAPPED IN ABUSIVE ‘DRUG REHAB CENTRES’

To those outside our field of therapeutic schools and programs, it makes sense that Matt Shea‘s article from May 2013 in Vice titled American Teens are Being Trapped in ‘Abusive Drug Rehab Centres’ is alarming.

To those of us in the field it’s a joke. You can read the whole article here: http://goo.gl/zW43F and judge for yourself. It’s a joke not because it’s inaccurate and not because there are no failures within the industry. It’s a joke because, just like so many other ‘journalists’ he paints a picture with such broad strokes that Mr. Shea fails to really understand the pressures, the people and, as cliche as it may sound, the passion with which so many in this field work. Mr. Shea fails to sort out the fiction from fact.

But how else can a budding journalist get retweeted and get his name out there without this version of quicky-journalism? Had Mr. Shea visited programs like many of us in the mental health and educational consulting world do, he would quickly meet and have experiences  which deepen his 2 dimensional paradigm. He would have been driven out into the remote and hot Utah desert to meet with small groups of teens guided by thoughtful and well-trained staff working on individual enrichment projects. He would leave thankful he never had to endure a Spring or Summer like they do yet, somehow, understands that this programming is providing a level of nurturing and structure significantly lacking in their home lives.

Let’s address the reference and correlation Mr. Shea makes between the therapeutic industry and Josh Shipp of MTV fame. Let’s revisit part of Mr. Shea’s article now…

Shipp is your classic Jerry Springer brand of therapist – no real qualifications, a huge ego and a penchant for money and entertaining TV over science and genuine psychology. “I’m a teen behaviour specialist,” he says in the intro. “My approach is gritty, gutsy and in your face.”

If he had actually spent time with Josh Shipp AND real mental/behavioral health and substance abuse professionals – he would very quickly understand that Mr. Shipp (…Mr. is used loosely here) does not represent the values of folks in this industry, an industry that is run by licensed clinicians and professionals. Mr. Shipp is nothing more than a court jester providing entertainment. He’s a monkey with two cymbals making noise and no signal for his ‘edgy’ reality-TV pushers at MTV (MTV is still around?). Occasionally, I’m sure there are teens and even parents (and maybe the rare delusion clinician) that hear the Shipp-Clown-message and it connects with them – changing their lives forever. But an overwhelming majority spend no more energy than a giggle or slight frown. Mr. Shipp does not have a degree, license or any sort of evidence-based training. He graduated from “Life Experience College” which sounds ‘super cool’ to the teens and teen parents he markets his wares to but there is no depth. He’s a can of soda full of empty calories. The therapeutic industry and Mr. Shipp are as polar-opposite as a Kardashian and Bill Moyers. And yes, we recognize as cold as it may sound, it’s an industry.  Just like cancer treatment, just like teaching, and just like daycare. If it were not an industry and did not have the same oversight as other industries, there would be little oversight. Trust me, you want therapy to be part of an industry. Industrialization provides codes of conduct, ethical guidelines, evidence-based treatment standards, inter-disciplinary work and research. NATSAP is an example of this type of self-imposed quality control.

FYI – Therapeutic wilderness programs are not boot camps. Therapeutic boarding schools are not military schools. There may have been some greedy, old-school meat-heads that sold parents on boot camps decades ago, but in the therapeutic world, those non-clinical programs as a laughable as Josh Shipp which may be why he talks about them in his MTV show. Boot camps and military schools are dying out and, thankfully, being replaced by sophisticated, evidence-based programs with transparency and clinical integrity. Not every program is awesome but, neither is every physician or dentist.

Mr. Shea, I make a challenge to you. Join me on a tour to visit 5 therapeutic programs. Together, you and I will kick the tires, dig through the closets and truly get to the bottom of whether this universe of programs is as detrimental as you propose. We’ll spend 2 days out in the back-country, in storage rooms with gear, and circled up in treatment centers. After that, I challenge you to write the same article blasting this world that has helped so many families. Not likely to happen.

Definition: Education Consultants, Case Managers, and Therapists oh My!

Those of us in mental, behavioral health and substance abuse fields generally know the difference between all the different professionals that support individuals and families. Unfortunately, we don’t always do a great job of helping clients understand the differences (and similarities). So, without further explanation, we present a humble attempt at defining professionals you may come across.

Educational Consultant: Also known as E.C.s, educational consultants started out decades ago helping families get their kids into college, private school and boarding schools. As family needs changed, so did E.C.’s focus. Nowadays, E.C’s serve families looking for academic advice and placement recommendations. In times of crisis, parents are often overwhelmed by a barrage of emotions, options and information. The confusion and desperation associated with having a struggling teenager or child can be extremely difficult. Parents may not be aware of the choices available, or may not be able to decide on their own which alternative best meets their situation and the needs of their child. Among the questions consultants often hear: How do we know when treatment is necessary? What would be best for our child? Is an intervention needed? Should we find a residential program? Would a wilderness therapy program be a good choice, or would an emotional growth boarding school be better? There is no one certification or academic program for educational consultants. Their quality and experience span a huge continuum.

Case Manager: Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. Basically they specialize in the organization and treatment planning for families that need finding a treatment program or need help transitioning their child back home. Educational Consulting is often a part of good case management. Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. The case manager helps identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source. Case management services are best offered in a climate that allows direct communication between the case manager, the client, and appropriate service personnel, in order to optimize the outcome for all concerned. Not unlike E.C.’s, Case Managers do not require certification or specific academic credentials but are often clinicians with at least a Master’s degree in a disciplin like counseling, psychology, social work or marriage and family therapy.

Therapist: A therapist is a general term for counselors, psychologists, psychiatrists, psychotherapists and psychoanalysts. They are trained professionals that treat mental and behavioral health and substance abuse problems through talk, discussion and interaction. A therapist helps clients you learn about conditions and moods, feelings, thoughts and behaviors. Therapy helps the client learn how to take control of one’s life and respond to challenging situations with healthy coping skills. There are many specific types of therapy, each with its own approach. The type of therapy that’s right for a client depends on their individual situation. Therapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.

Check back next time when we talk about Counselors, Psychologists, Psychiatrists, Social Workers and Clinicians. Got a clinical term you’re confused about? Contact us and we’ll post info on it. More than likely, you’re not alone in your confusion.

 

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.

Therapists: Change in Medical Coding Threatens Mental Health Care

Reprinted from NBC News

By JoNel Aleccia, Staff Writer, NBC News

Marc Milhander conducted more than 100 psychotherapy sessions in the first few weeks of this year, treating patients ranging from the mildly anxious to the severely depressed and the 24-year-old with antisocial personality disorder who really wants to get his hands on a gun.

But Milhander, 54, a psychologist who co-owns a busy Niles, Mich., counseling center, is getting pretty anxious himself.

He’s among a growing number of U.S. mental health professionals who say their insurance claims have been denied — and their payments have been withheld — because of problems resulting from nationwide changes in psychotherapy treatment codes that took effect Jan. 1.

“I’ve been paid for five hours of work for the month of January,” said Milhander, who supports a staff of four and oversees 300 patients a month. “I just wrote a big, fat check out of my personal bank account to keep us afloat.”

Worse, Milhander and others say systemwide delays and outright denials of payment could last for months, jeopardizing not just the nation’s 500,000 providers, but also access to care for millions of mentally ill Americans. Federal estimates suggest that nearly 20 percent of the adult U.S. population has some form of mental illness.

“So far, it’s chaos,” said Randy Phelps, deputy executive director for the American Psychological Association, who says hits to the coding section of the APA’s website have topped 300,000 in the past month. “It’s hard to evaluate how widespread this is.”

The problem comes amid growing demands for better interventions with the mentally ill in the wake of shooting massacres in Aurora, Colo., and Newtown, Conn.

“Compliance with treatment is a sketchy thing to begin with,” said Sam Muszynski, director of  the office of health care systems and financing for the American Psychiatric Association. He fears that financial fallout may force some providers to disrupt care, leaving mentally unstable patients on their own temporarily — or longer.

“All it takes is one missed appointment,” he added.

The trouble stems from the first overhaul since 1998 of the codes used to describe — and bill for — mental health treatment. They’re among some 8,000 to 9,000 CPT, or current procedural terminology, codes used for all types of medical procedures.

The codes, produced by the American Medical Association, are updated each year, usually with no problem, experts say. But this year, changes to a mere 30 codes that affect mental health services have thrown a huge glitch into the system.

“There are some systems that aren’t even ready to begin accepting claims,” said Nina Marshall, director of public policy for the National Council for Behavioral Health.

She has been flooded with calls and e-mails, not only from providers confused about how much to charge and when they’ll get paid, but also from patients worried about care.

“I have heard from consumers saying that their providers can’t provide the services,” she said. “They’re reaching out to me with real concerns.”

The psychiatric codes were updated after vigorous lobbying by mental health care providers, who argued they weren’t being paid enough to treat today’s medically complex or seriously ill patients.

“What has come out of managed care in mental health is they go in for three days, they’re on meds, they’re barely stabilized, and being treated by outpatient providers,” Phelps said. “Nobody had reevaluated these codes for 30 years, but the world had changed tremendously.”

Payers unprepared

But the implementation has been difficult, at the very least.

Payers, including the federal Medicare and Medicaid programs, admit they weren’t prepared for the switch.

Some providers have used the new codes incorrectly — or not at all, a violation of federal law. Some government contractors logged extra “edits” into the codes, invalidating scores of submissions, Medicare officials told NBC News. Three weeks into the new system, federal officials had to send directives reminding everyone of the changes, said Brian Cook, a spokesman for the Centers for Medicare and Medicaid services.

The nation’s largest private insurers have had problems, too.

“The amount of changes and the work involved was much bigger than … the folks involved anticipated,” said Helen Stojic, a spokeswoman for Blue Cross Blue Shield of Michigan, where Marc Milhander practices.

Stojic couldn’t say how many Michigan claims had been denied or how many providers had been affected, but she acknowledged that many had not received payments in January — and that there was no firm date when they would.

“We’re going to do everything possible to get some dollars to them,” she said. “We certainly apologize for the inconvenience.”

For Milhander, the issue is far more than an inconvenience. He says worried about keeping the doors open with so little money coming in.

“Right now, we’re working for free,” he said.

Steven Perlow, president of the Georgia Psychological Association and a psychologist in private practice, says he hasn’t received January payments from private insurers, either.

He, too, has heard from dozens of frustrated colleagues worried not just about cash flow but also about code changes that shave more off of insurance payments. One change, for instance, trims a typical therapy session to 45 minutes and cuts reimbursement by $1 each time.

“It’s just $1 less, but nonetheless, we’re being asked to take less,” said Perlow, who seeks about 45 patients a week.

The biggest worry, though, is that the coding chaos will affect care for vulnerable patients fortunate enough to have some form of insurance coverage.

‘A really large job’

About 46.5 million adults in the U.S. — or nearly 20 percent of the population — suffer from some form of mental illness, according to government statistics. About 11.5 million suffer from serious conditions.

It’s not clear how many actually have access to care, but many do not, and anything that jeopardizes existing support is a problem, experts say.

“We are ethically bound not to leave patients hanging,” Perlow said. “I will personally see people for a sliding scale … there have been situations where I’ve seen people for free.”

Milhander said he, too, would continue to treat patients — including the most severely ill who require medication management — as long as possible.

“My staff are understandably panicked, fearful that they won’t have the financial resources to get through this,” Milhander said. “I’m letting them know I will carry them through this period financially, for as long as I’m able.”

How long the denials and delays may last is anyone’s guess. Medicare officials say they’ve begun reprocessing claims that were denied in the first weeks of the year. But for some Medicaid programs, the problem is so complex that they may not be able to get up to speed to process claims until June, experts tell NBC News.

Private insurers are aware of — and working on — the problem, said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry association.

“Implementing these codes is a really large job,” she said, noting that some plans are offering alternate payment processes until the problem is fixed.

Still, some providers may stop participating in insurance plans that delay too long, or cut fees, and others might be forced to close shop entirely, unable to go for weeks or months without income.

‘How scary is this?’

That’s a frightening thought to the family of Milhander’s 24-year-old patient, who suffers from paranoid delusions and only recently has been stabilized under the psychologist’s care.

“Marc is the only person that he is able to talk to. This is his only release,” says a family member, who asked not to be identified, even broadly, for safety reasons.

The young man suffered a head injury as a teenager. He has threatened to burn the house with people in it, threatened to get a gun, threatened to “come back and haunt” family members after his own death.

“We hear about these scary things that happen. How scary is this, now that the insurance is having these issues?” said the family member. “How many people are going to be left untreated out there?”