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Disordered Eating is Increasing, but There Are Plenty of Barriers to Treatment

As many Americans struggle with mental health, new reports show that eating disorders in particular increased in the last year. Unfortunately, many people are not getting the treatment they need.

Ongoing waiting lists and backlogs have delayed treatment for people with eating disorders. Because eating disorders often accompany other physical and mental health conditions, long-term success can be difficult to achieve. And finally, many experts are challenging the way that providers and the general public think about disordered eating and how to treat it.

Delays in getting eating disorder treatment

A report by nonprofit FAIR Health found that, from January to November 2020, eating disorders increased among individuals aged 13-18 years. (Download the PDF here.) This has created an increased demand for treatment that providers are scrambling to meet.

According to NPR, a nationwide network of 15 different hospitals have reported a doubling in average admissions for eating disorders in teens. In fact, health leaders in Milwaukee, Wis., have noted this has led to a backlog in services.

New patients may have to wait weeks or even months to be seen. Isolation and limited physical activity may have worsened preexisting depression. Disruption of routines and structure also make healthy habits difficult.

Eating disorders can be complicated to treat

According to the National Institutes of Health, eating disorders can increase the risk of medical issues and even mortality. In particular, anorexia nervosa is associated with the highest mortality rate of any mental health condition.

Eating disorders also can accompany other mental health conditions. Researchers reported in the Journal of Psychiatric Research that individuals diagnosed with an eating disorder are more likely to also have obsessive-compulsive disorder.

Besides finding an effective treatment, relapse is also an ongoing problem. A new study of adolescents with anorexia found that many of them can predict their future weight after discharge from an inpatient treatment program. Clients who expect to lose weight after discharge should receive more intensive aftercare, the researchers note.

Changing how we think of eating disorders

Eating disorders have long been thought of as a problem of the wealthy, especially among white females. However, research shows that disordered eating is also found at lower socioeconomic levels.

Writing in Eating Behaviors, researchers from the University of Minnesota found that women of lower socioeconomic status were more likely to show high body dissatisfaction and unhealthy weight control behaviors, such as skipping meals. Men of low economic status were more likely to engage in extreme behaviors, such as taking diet pills. However, differences between socioeconomic groups decreased with models that adjusted for race and body-mass index.

Michael Lowe, PhD, a professor in Drexel University’s College of Arts and Sciences, has been reevaluating how researchers and the public define dieting and view weight loss. He notes that the greater availability of food in wealthier nations goes against the body’s natural survival drive, making it difficult to control food intake.

Treating eating disorders is a complex, sensitive concern for you and your clients. The right EHR solution can help you track outcomes and make better treatment decisions, increasing your practice’s value.

BestNotes EHR software has been designed specifically for behavioral health providers and their clients, so you both get the results you deserve. Get in touch with us today to learn more.

date:  Sep 17, 2021
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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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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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Wellness for Behavioral Health Clinicians: Addressing Burnout

Clinicians have had a rough time during the COVID-19 pandemic, and many have been experiencing provider burnout. Burnout may involve:

Job dissatisfaction
Physical and/or emotional exhaustion
Increased cynicism
Lower motivation
Lower empathy
Feeling ineffective

So how can clinicians recover from burnout? Better still, are there ways to prevent it?

Risk factors for clinician burnout

Some of the most common risk factors for clinician burnout include:

Heavy workloads: High demand for behavioral health services can lead to overloaded schedules and unrealistic expectations, all of which can create exhaustion and stress for clinicians.
Poorly designed workflows: Inefficient work systems and administrative demands can frustrate providers, especially when they have many tasks that they consider distractions or a lower priority.
Sustained psychological effort: Behavioral health can be emotionally draining, even when the clinician finds it meaningful and rewarding. Attending to a client’s needs can take a serious mental toll, especially if a client dies or has a serious medical event.
Lack of autonomy: Providers who do not feel some level of control or flexibility in their roles, or freedom to make decisions, can become discouraged and anxious.
Poor client relationships: Not all behavioral health clients follow their clinician’s suggestions. If a client ignores medical advice, demands unnecessary medical care, or otherwise behaves disrespectfully, providers are more likely to experience lower job satisfaction and higher emotional exhaustion.

A thorough review of the risk factors can be found in the 2019 book, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.

Recovering from burnout

Are you or a partner experiencing burnout? Here’s what to try before quitting your job:

Form healthy habits: Don’t neglect your physical health. Proper diet, sleep, and physical exercise go a long way toward helping you recover from burnout. Start with small decisions, such as taking a brisk, ten-minute walk, or choosing healthy meals over comfort foods.
Don’t suffer in silence: If you are experiencing burnout, talk to your management or partners about it and brainstorm changes you could make at your practice. Confide in a close friend or consider seeing a counselor yourself.
Start small: It’s likely that many different factors, rather than one big event, contributed to your burnout. In the same way, recovery may involve small steps and gradual improvements.

Preventing clinician burnout

Behavioral health practices have several options for preventing burnout in their staff. (These options can also help alleviate burnout that has already happened.)

Consider hiring temporary staff. Many employers are struggling to fill workforce gaps, so this can be tricky. But even if you can’t afford or find a full-time staff member, consider hiring a temporary or part-time employee, or even a virtual assistant, to help reduce the workload.
Look for opportunities to streamline or automate. This can reduce the need for providers to perform administrative tasks so they can focus more on client care. Appointment reminders, for example, can help nurture client relationships while lightening provider load.
Consult available expert resources. For example, The Ohio State University has been promoting wellness initiatives among clinicians to help reduce burnout. One of these is Mindfulness in Motion, an 8-week program offers resiliency tools to help improve functionality and stress coping.

Frustrating, ineffective technology is a common cause of clinician burnout. Make sure your EHR software is designed specifically for your needs as a behavioral health provider. BestNotes offers customized solutions and documentation options to help your organization be more efficient and less stressful. Contact us today to learn more.

date:  Aug 03, 2021
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