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Wellness for Behavioral Health Clinicians: Maintaining Healthy Boundaries

Working as a behavioral health clinician is rewarding but emotionally exhausting. This can lead to serious burnout, which can harm relationships, physical health, and the future of your career.

Practicing healthy boundaries is important for managing your career responsibilities. Here’s how to recognize and keep healthy boundaries with your behavioral health clients.

What do healthy boundaries look like?

In general, healthy boundaries between a clinician and client means that interactions only occur in the office (or facility), during scheduled times. The clinician is not emotionally involved with the client beyond normal, professional concern.

Perhaps most importantly, clinicians and clients should not have another type of relationship outside of therapeutic sessions (what is known as a “dual relationship”). Your client should not also be your accountant, family member, coworker, and so on.

This may be more challenging in less populated areas, or communities with fewer mental health professionals. You may unintentionally meet a client outside of sessions, such as at the grocery store. In that case, do not initiate a conversation. If you cannot avoid it, keep the interaction brief and professional, and avoid discussing anything that belongs in your scheduled sessions.

What are some examples of boundary violations?

Crossing boundaries can harm the therapeutic relationships, jeopardize your career, and put a client’s wellness at risk. Clinician boundary violations may include:

Interacting with a client on social media
Accepting gifts from a client
Forming a business, social, or sexual relationship with a client
Inappropriate physical touching
Revealing too much about yourself
Excessively long sessions
Lengthy or deliberate interactions with a client outside of therapy sessions

Different organizations, settings, and cultures may have different boundaries. For example, if a client is excessively afraid of flying, their therapist may accompany them on a flight as part of their exposure therapy. Child therapists may hug their clients or visit them in the hospital.

How do you maintain healthy boundaries?

Even if you understand what appropriate or inappropriate boundaries look like, they can be difficult to maintain. Here’s how to help you keep healthy boundaries:

Decide what you will and will not disclose about yourself to a client, and under what circumstances.
Set specific rules with clients and let them know what is and is not appropriate.
Practice speaking up for your boundaries. For example, if you have trouble keeping to your set session time, practice saying, “I’m sorry, but our time is up. We can schedule another session to continue this discussion.”
Get familiar with professional standards for boundaries, including state laws and licensing boards.
Do not give your clients access to your social media profiles. Set your profiles to private or restricted access.

You may struggle with boundaries in other ways, such as taking on too much work. Preserving healthy client boundaries can help you develop good habits in other areas of your life.

Behavioral health clinicians may struggle to prevent burnout while maintaining professional standards. At BestNotes, we believe that the right tools can help you do both.

BestNotes EHR solutions were designed with you in mind, so you can run an efficient practice with better client results, higher revenue, and lower stress. Contact us today to take the next step in making your career even more satisfying!

date:  Sep 14, 2021
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Opioid Lawsuit Payments, Health Inequities, and Other Florida Behavioral Health News

Are you a behavioral health provider operating in Florida? Here is a quick roundup of some of the mental health and substance use treatment news emerging from the Sunshine State.

Florida Receiving Funds in National Opioid Lawsuit

Florida will receive over $1.3 billion from pharmaceutical distributors AmerisourceBergen, Cardinal Health, and McKesson, in a national opioid lawsuit agreement reached in late July. Opioid manufacturer Johnson & Johnson will pay Florida $300 million over nine years.

Florida communities may join in the agreement within 150 days. After that, they could start receiving some of the funding next year. Localities in Florida have been working with the state attorney general’s office to draft a memorandum of understanding for how the money will be distributed.

New Florida Law Focuses on Health Disparities

Florida Gov. Ron Desantis recently signed into law HB-183, which is intended to improve healthcare for minorities and directs $4.4 million to the Office of Minority Health and Health Equity. Under the new law, the office will create county liaisons across Florida to improve local health issues.

Dr. Kyaien Conner, Associate Professor of mental health law and policy at the University of South Florida, helped create this new law. In her work in low-income, African-American areas, she says she saw lower rates of mental health treatment, driven partly by negative community attitudes toward seeking mental healthcare.

Self-Medicating a Problem for Opioid Epidemic

Mental health has gained more attention in recent years, especially during the COVID-19 pandemic. Unfortunately, many people struggling with mental health needs have been increasingly self-medicating, especially with opioids. Jaime Bridges, a clinical social worker with Orlando Health, notes that the use of fentanyl has become a major problem, even outside of the COVID-19 pandemic.

This month, the Orange County Drug Free Office launched a new initiative in response to increased opioid-related overdose emergency calls. Volunteers are offering toolkits that include nasal naloxone, sold under the brand name Narcan.

Charlotte County Introduces Interactive Health Dashboard

The Department of Health in Charlotte County (DOH-Charlotte) has launched an interactive dashboard that allows residents to access insightful health data. Designed by DOH-Charlotte and mySidewalk, the dashboard provides information about social and economic determinants of health. Public health experts hope this will help them better target specific community needs.

For example, dashboard data show that Charlotte County’s ratio of residents to mental health providers is 885 to 1, compared to a statewide rate of 622 to 1. This may indicate a need to bring more mental health resources into the county to help reduce that disparity.

Researchers Examine Whether Psychedelics Can Reduce Alcohol Consumption

Florida-based biotech company Psilera is working with University of South Florida (USF) researchers to research the possibility of using psychedelic derivatives to reduce alcohol consumption. The preclinical studies will conduct in-vivo screening of Psilera’s psychedelic-inspired new chemical entities. The study will also use the psilocybin compound mimic psilacetin, known as 4-AcO-DMT, which may reduce opioid and nicotine dependences.

Florida behavioral health organizations continue to address challenges related to substance misuse, underserved communities, and addressing social determinants of health. BestNotes’ EHR solutions are designed specifically for behavioral health practices, with customizable, easy to implement options for meeting these challenges.

We help make your organization run smoothly, reducing stress for your staff and improving your clients’ health outcomes. Contact us today to schedule your free demo.

date:  Sep 07, 2021
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Why Your Treatment Facility Needs Data, and How to Create a Data-Positive Workplace

As healthcare becomes increasingly digital and moves to value-based care, data is playing a greater role. Behavioral health facilities must use data to demonstrate their value, meet accreditation requirements, and make better treatment decisions.

This can be a challenge for organizations that are not used to collecting, analyzing, and reporting on data. Before you can use data effectively, your behavioral health treatment facility must have a culture that understands the importance of data and how to use it effectively. Here’s how to start creating that culture.

What is data-informed treatment?

First, what do we mean when we talk about data-informed treatment? It means that collecting data becomes part of an organization’s weekly progress monitoring. Data is analyzed and used for individual treatment decisions and to determine how effective those treatments are. Data can also help make decisions about overall programs.

Data can also be used to guide your facility’s financial and operational processes. You might refer to data findings to help find ways to increase revenue and decrease costs. It can help drive innovation, helping to determine which services are the most effective for your clients and stakeholders.

This type of decision-making can be a sticking point for clinicians who may not be convinced that it’s worthwhile to use data alongside their own expertise. However, research shows that data-informed decisions can lead to better client results than those decisions made by the clinician alone.

Creating the data-driven culture

A workplace culture is a set of shared values and beliefs that drive behavior and performance. Note that this is different from work climate, which involves overall attitudes about the organization.

So how do you bring a pro-data attitude into your organization’s culture?

First, you should assess your current organizational culture. Evaluate the quality and performance of the methods you currently use to collect and apply data, if you have them. This assessment may be a one-time event, or you can make it an ongoing process as your organization evolves.

You can conduct assessments in many ways. You might hold a meeting where people offer feedback, or distribute an anonymous survey. You may bring in outside consultants. Once you have completed the assessment, determine what areas need the most attention or change.

Other important elements in creating a data-driven culture include:

Get leadership on board by explaining how data collection supports the organization’s core ideology.
Clearly define, communicate, and practice the appropriate ethics of data collection and use.
Identify the roles, responsibilities, and chain of command for all team members involved in data collection, analysis, storage, and use.
Encourage feedback, including anonymous, from anyone involved in data collection, from frontline staff to clinicians.

The way you implement these changes will depend on your facility’s particular needs. If you have a strict environment where security is important, you may need to use a more managerial, controlled, top-down approach to change. Other organizations may need a more flexible, collaborative approach that evolves over time.

When you move to data-informed treatment, you also need the right tools to help you gather and analyze this data. OutcomeTools by BestNotes is a secure delivery and analysis system that lets behavioral health organizations track their effectiveness through electronic outcome questionnaires.

OutcomeTools helps simplify administration and takes the work out of outcome studies. Get in touch with us today to learn more about how OutcomeTools can help you start making better decisions, sooner.

date:  Sep 01, 2021
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Why Progress Monitoring Is Key to Your Behavioral Health Practice’s Success

Monitoring a patient’s treatment response has become standard practice for physical health conditions. For example, medical providers use regular blood tests to track how a patient responds to their diabetes medication.

Progress monitoring is less common in behavioral health. However, the shift to value-based care has put pressure on many behavioral health providers to monitor client progress and track outcomes. This makes progress monitoring vital for the success of any behavioral health organization.

(Want more information about progress monitoring? Check out our webinar video here!)

What is progress monitoring?

Progress monitoring (PM) uses evidence-based measures to track meaningful changes in a behavioral health client’s life. These changes are measured at regular intervals during the treatment process. Clinicians discuss these results with the client.

Some examples of PM tools used in behavioral health include:

Self-reported questionnaires
Urine tests for substance use
Client attendance in therapy sessions
Neuropsychological tests of brain function

Not every individual will have the same response to a particular treatment, even for the same condition. Monitoring a client’s symptoms over time is one of the best ways to know whether a particular treatment method is working or not.

Barriers to progress monitoring

Although regular PM is important for client progress, there are plenty of obstacles that can prevent behavioral health providers from fully implementing it. Some of these include:

Lack of organizational infrastructure
High staff turnover
Lack of knowledge of how to PM appropriately
Heavy clinician or support staff workloads
Not recognizing the value of PM
Fears of detracting from clinical work

However, evidence suggests that PM can help promote efficiency in a behavioral health organization by helping to guide treatment planning. Clinicians can identify deterioration in clients sooner, and can even become better at predicting client deterioration. PM helps reduce treatment failure and readmissions, which not only is better for the client, but it is also cost-effective for providers and facilities.

How to conduct successful progress monitoring

What does an effective PM plan look like? It should follow these steps:

Choose a tool to help collect, store, organize, and analyze data (this may be part of an existing EHR system)
Review the data that you find
Discuss your findings with the client
Conduct regular clinical staff meetings to discuss data

Of course, this is a general outline. Your organization’s specific PM strategy may vary depending on the tools you use and the data you collect. That will also depend on factors such as your client base, the conditions you treat, and the types of treatment methods you use in your practice.

When discussing results with a client, make sure to discuss not just their current condition, but their progress over time. Clinicians should also discuss strengths as well as setbacks, and take a collaborative approach to interpreting the symptoms and data. (These same approaches also work when discussing PM findings with all clinicians at staff meetings.)

Starting a PM plan can seem daunting. However, the right tools can make the process simple and flexible for your behavioral health organization.

At BestNotes, we’re committed to making life easier for behavioral health clinicians. Our OutcomeTools takes the work out of outcome studies and PM so you can focus on helping your clients and keeping your organization running smoothly. Get in touch with us today to get started on making your behavioral health practice a success.

date:  Aug 17, 2021
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What Providers Should Know About Standards of Behavioral Health Care and Mental Health Parity

Under a series of federal laws, medical insurers must provide equal insurance coverage for behavioral health treatment and for medical and surgical care. Otherwise, payers and insurance policies tend to cover mental health treatment at lower levels than physical illness.

Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, requiring equal coverage of treatment for mental illness and addiction, known as mental health parity. In November 2013, the federal government released rules for implementing the law.

However, not all insurers have followed this rule for equal coverage. America’s Mental Health 2018, a study of access to mental health care in the United States, found that 42 percent of Americans considered “cost and poor insurance coverage” to be some of the largest hurdles to mental healthcare access.

Lack of insurance coverage for mental health treatment can be devastating for patients with substance misuse and serious mental health disorders. It can also create problems for behavioral health providers when payers deny prior authorization or insurance claims.

Mental Health Parity and the Wit Case

If payers have restrictive guidelines for care, even providers that follow generally accepted standards may have to justify their treatment decisions. This issue came to a head in Wit v. United Behavioral Health, also known as the Wit case.

In March 2019, the U.S. District Court for the Northern District of California found that United Behavioral Health (UBH) wrongfully denied plaintiffs coverage for mental health and substance use services. UBH’s Level of Care Guidelines and Coverage Determination Guidelines were more restrictive than general standards of care.

In its ruling, the court listed eight principles of accepted standards of care. Both patients and providers can refer to these principles when seeking or providing appropriate behavioral healthcare:

Treating the underlying condition, not just current symptoms
Coordinated treatment of co-occurring behavioral and physical health conditions
Treatment should be the least intensive and restrictive while also safe and effective
When uncertain, err on the side of caution and place a patient in a higher level of care
Behavioral health treatment should maintain functioning or prevent deterioration
Duration of treatment has no specific limit
Account for the unique needs of children and adolescents
Appropriate level of care should use a multidimensional assessment

How to Advocate for Behavioral Health Clients and Practices

Drawing from the Wit case, National Council for Mental Wellbeing has developed a toolkit, “A Compelling Argument For Facilitating the Equitable Use of Generally Accepted Standards of Care,” available as a PDF download.

The toolkit aims to help behavioral health clinicians and organizations claim their roles as expert authorities and ensure that clients receive appropriate, medically necessary care. It is meant for providers whose claims have been denied due to misaligned standards of care.

The toolkit includes:

Appropriate steps to take when faced with excessively restrictive claims denials
An infographic highlighting the Wit case
Appeal letter templates for both providers and clients
Talking points to use in phone conversations with reviewers

These resources can help your behavioral health organization better advocate for your clinicians and your clients while demonstrating your expertise and conviction.

Behavioral health billing and reimbursement shouldn’t be complicated. BestNotes EHR solutions were developed specifically for behavioral health and substance use disorder treatment providers to help you operate with less stress and frustration, helping you stay compliant and get reimbursed faster. Contact BestNotes today to learn more.

date:  Aug 09, 2021
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