Texas Counselors Creating Badass Businesses

10. Paperwork You Must Clean Up Before 2023

December 01, 2022 Season 1 Episode 10
Texas Counselors Creating Badass Businesses
10. Paperwork You Must Clean Up Before 2023
Show Notes Transcript

What often stops us from taking action is the story our fear tells us. We’re afraid that other people might laugh at us or judge us. But you can't have that mindset when it comes to diving in to your intake paperwork and your policy and procedures manual.

Today’s episode is all about understanding and overcoming that fear and getting your paperwork up to speed before Q1. I had to fight it too! Learning about the rules as a licensing board liaison made a massive impact on my resolve to fight through my own fear and show and tell my own paperwork. Through my blog and You Tube channel, I have shown countless counselors my own paperwork mistakes so they know what to do (and what not to do).

This episode is packed with actionable tips and tools that you can use to defeat procrastination, perfectionism, and negative thought patterns and dive in to your own paperwork and GET IT DONE. We'll discuss intake paperwork, a fair late cancel/no-show policy, and why a policy and procedures manual can make your office run like a finely tuned machine.

I’m so grateful for this time of year when I can help counselors utilize the slower holiday time and get ready to hit the ground running in 2023.  Listen in to get a new perspective on uncertainty and learn the vital habits that will set you up for success. Download free templates here: https://katewalkertraining.com/?p=30233&preview=true

Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.

[00:00:00]

Introduction

Kate Walker:          Hey, it’s Dr. Kate Walker and I’m going to talk about probably the most important part of introducing or reintroducing your practice to your community. You have got to have this stuff ship-shape and ready to go, no questions asked, 100% figured out. So I will walk you, step-by-step, through my intake paperwork so that by the time you finish this you’ll understand a couple of things. You’ll understand, first of all, that you don’t have to reinvent the wheel. You can literally use my templates or anyone else’s and modify it for your practice. Number two, you’ll understand how to have a fair late-cancel no-show policy, how to get your procedure and policies manual in shape for the new year. Alright, let’s get to work.

                                  Feel free to grab what you like or disregard the rest. You at least have a template if you’d like to use it. The beginning talks about what counseling is and what it is not. This, along with your theory, will help you conceptualize those three sessions that you talk to your clients about during that ten-minute consultation. So I specifically say that my initial assessment can last up to four sessions. So, for me, an initial assessment can last up to four sessions. Now, if we continue on, you’ll see that I put my professional fees and changes and cancellations in the same area because they relate to one another. Now, you can put whatever fee you’d like. If you take insurance, you will have a fee that is different from what your insurance company may reimburse you for. So, for example, if you are paneled with Magellan and they only pay $80 an hour, but if you are cash-based and your rate is $200 an hour, you would want to put your $200 rate here, not the rate that that particular insurance panel would pay you. 

                                  Now, the most important part of a fair late cancel/no show policy is transparency. Problems erupt when there are discrepancies, or clients feel like you didn’t tell them that. So it’s not enough just to put this here; you have to make sure that you tell new clients exactly what your late cancel/no show policy is, but this is a start. So once you state your fee per hour – not the insurance rate, your actual fee – let them know exactly how many hours ahead of their appointment they must give you notice. Now, I explain to my clients, I pre-sell their time at that time. So it doesn’t matter what happens after that, they’ve purchased that time, it belongs to them. If they decide to come, great, if they don’t come, that’s fine. If they want to give the time to another family member, that’s fine, too. 

                                  The way this is conceptualized is a face-to-face office because what I’m trying to help my clients understand is even if they had a sick child or something came up unforeseen, as long as they could get to a confidential location, they could still keep their appointment because I had HIPAA-compliant telehealth options. Now that I’m completely virtual, I really don’t need to have this in there. They’re either going to show up, or they’re not. I make sure that I indicate very clearly how to contact me to let me know they’re not coming. I specifically say we do not take cancellations via email. I may not accommodate cancellations made after hours or on holidays. And, cancellations with less than 24 hours’ notice will result in a fee equal to the total amount of the missed session – in other words, the entire fee. I don’t do a $10 fee or a $50 fee because again, in 24 hours, I can’t sell that time again; I can’t resell it, so it’s going to sit empty. That is an inconvenience to me and I want to make sure in my fair late cancel/no show policy, my clients understand that once they purchase that time, it belongs to them; it’s not mine anymore.

                                  Now, I do have a policy here after two no shows or cancellations clients will need to pay a retainer, and then if they no show that they forfeit the retainer. I’ve never had to use that.

                                  Now, what I want you to hear clearly is this policy is fair because it’s transparent. It may seem very strict, but the client knows upfront what they’re choosing if they cannot come. Does that take away my agency if I decide to let it slide one time, or if I know this client has a kiddo with cancer and they had an unexpected visit to the hospital the night before? Of course it doesn’t. I mean, I can still make the final judgment of how I want to enforce this fair late cancel/no show policy, but I want you to keep in mind countertransference. If you already know that there’s some countertransference going on inside of you for a client, whether it’s good or bad, ask yourself if you’re about to let this cancelation slide, think of your most difficult client and ask yourself, would you give that person the same consideration? If you can’t, then you may need to look at how you enforce your late cancel/no show policy and rewrite it. It doesn’t have to be strict. You can have a $10 late fee. You can have that you need five days’ notice. This worked for me because of the way my practice was set up. Whatever you decide on, what makes it fair is transparency and communication and fairness on your part. It’s just like parenting. Rules for one have to apply to all, or better have a good reason why.

                                  [ad break]

                                  This episode is brought to you by the 40-Hour Training to Become a Supervisor in Texas. Not just any training, by the Kate Walker LPC/LMFT Supervisor Training completely online! It’s the only all-in-one 40-hour LPC/LMFT supervisor training course and community designed to grow your skillset and give you more research-based resources all in less than 30 minutes a day. No bots, no BS, just a great course to get you up to supervisor. The Kate Walker Training 40-Hour LPC/LMFT Supervisor Training Course, check it out!

                                  [end ad break]

                                  I have consulted with attorneys, I’ve decided to leave mine in, but just know that in Texas, it’s hard to enforce this, so I highly recommend if you’re going to have an additional fee or a higher fee for court testimony, you consult with your trusted attorney and your malpractice insurance just to be sure. Because in Texas, if you get subpoenaed, you have to go. There is no, well, I’m not going because I haven’t been paid yet.

                                  In my consult for treatment, I’m very clear about how to contact me. As a strategic family therapist, I rarely contact my clients and I rarely allow them to contact me. That’s my theory. It’s my theory-based stance. Your theory may be different, so whatever you choose, just make sure that you are clear. As I mentioned before, since I pre-sell my times, it doesn’t matter to me if they’re running late, they’ve already bought the time. And if I notice that 15 minutes into the session they’re not here, I’ll give them a call, and if they tell me, oh my gosh, we’re in the hospital with the kiddo, the chemo, all of the things, then I can talk to them about what happens next.

                                  My Facebook and social media policy, in a nutshell, states that social media is not an avenue for communication. If you reach out to me, I won’t answer, and if you try to friend me, I won’t friend you, and if you out another client of mine out of malice or whatever, I will prosecute you to the full extent of the law in order to protect that client’s information. And depending on what state you’re in, this may look different. In Texas, we just have to be mindful that there is no duty to warn, and so make sure that your statements here reflect your most current laws. 

                                  I do have a section on counseling via technology because my practice is entirely online. So I must let them know about the limitations of technology, there are a lot of different places that you can get great procedures. If you have not done a technology training, I highly recommend that you do that, especially if you are looking for ways to make sure that you are providing the best teletherapy, the most ethical teletherapy that you can.

                                  Finally, I talk to my clients about professional records. I don’t see a lot of minors, in fact, these days, very few, so it’s still important to address what happens with records with a minor and make sure that you’re reflecting the most recent laws. One of the things I have on my website is a download that I got right from the HIPAA website, the dot gov website, it’s a PDF that explains what HIPAA is and I make sure that my clients are able to download that and that they’ve acknowledged that they received that. And every service agreement, consent for treatment, must end with a way to contact the licensing board if your client wishes to file a complaint.

                                  Okay, now let’s talk about how to get your policy and procedures manual in shape for the new year. Now, what you’ll get today is more than just an understanding of kind of why we need one more whatever, and maybe you’ll get that, but what I want you to really understand from today is this is different from your service agreement. This is different from a consent form. This is a multi-faceted, multi-dimensional, magnificent document that is going to grow and change throughout the year. It’s going to be something that you’re going to give to new employees as quickly as possible. It is going to serve as a training, it is going to serve as an orientation, it’s going to serve as a springboard to get your employees up to speed, and in a mental health practice, HIPAA-compliant. A good policy and procedures manual is always going to include a progressive discipline plan or an explanation of a progressive discipline plan.

                                  So one of the most important things I think a policy and procedures manual has to have – and you’re going to think I’m silly because it’s not the mission or anything like that, although that’s important, it’s a table of contents. And back in the day when we would put this thing in a three-ring binder, it was so easy to put dividers in and we could say, okay, section one, the organizational background; section two, office procedures; section three, emergency procedures; section four, progressive discipline plan; section five, a signature page. And then if we needed to add to those sections, it was super easy: we just opened the binder, put in the new information, click, and hand it back to the employee and we were good to go. Now everything is online, and you have to be a formatting genius to be able to keep all of this stuff together. But don’t give up, there’s a way to use live links with anchors. I can’t teach you that today but it’s definitely something to look into if you’re wanting to make all of these comments, all of these sections of your beautiful table of contents something that your future employees can just click, and it goes there immediately.

                                  Probably the second most important thing, I believe, in a policy and procedures manual are the job descriptions. Now, how many times have you heard people say, well, that’s not my job? It drives employers crazy, right, because we’re like, it’s everybody’s job. If you see a piece of paper on the floor, you pick it up. It’s not just the person whose desk it’s under. Well, systemic thinker that I am, what I know happens there is it creates a lot of resentment in the office because your morale is only going to be as good as the employee that you let get away with the most stuff. 

                                  So your job description is going to help you in two ways. Number one, it’s going to give everybody a job so they can be held accountable. Number two, it’s going to give you stuff to evaluate. So in your job description, if you have the clinical director job is to show up for work in the office five days a week, have an open door policy with employees, provide written evaluations once a quarter, provide super critical supervision to employees who don’t manage their paycheck – I’m just making this all up, but you have this job description with specific, measurable, trackable behaviors, then you can give an evaluation that makes sense when you say “exceeds expectations,” “meets expectations,” or “does not meet expectations.” 

                                  This is why when I do consultations and coaching, so many folks are pulling their hair out because they’re afraid to evaluate their employee. Why? Because they’re saying to themselves, wait a second, did I tell them that? Did I teach them that? Did I make sure that they knew that was their job? A good policy and procedures manual takes care of that because you’re putting down, in writing, what exactly the employee must do and what they’ll be evaluated on later. So if they get pissed off at their evaluation, if they don’t agree with the evaluation, now you two can sit down as co-collaborators and look at the job description and they can help you understand what they feel the job description is – you’re both looking at the same document now – and it results in a great conversation, or a progressive discipline plan moment, but we’ll get to that in a second. But if you have no job description, you have nowhere to start. 

                                  So if you’re going through your head and you’re like, I really need to get a policy and procedures manual going here, you could start with the table of contents. I’m going to include a downloadable one in the show notes and on the Facebook page and in the blog so you can have that for yourself. And I know some of you have some fabulous policy and procedures manuals that I know you’re sharing in Texas Counselors Creating Badass Businesses and that you’re sharing in the Step It Up group. That’s wonderful because we all need as much information as we possibly can. But if you’re not going to start with that table of contents, then sit down and spend some quality time with those job descriptions. Those job descriptions will save your bacon when it comes to the next part that I’m going to talk about, which is the progressive discipline plan. Yes, I know in the table of contents there’s a ton of other stuff, like where to put the key, you’ve got to put the pillows back in place before you leave the office, make sure you turn the lights off. 

                                  But the progressive discipline plan is what’s going to help you communicate expectations and hold employees accountable and ultimately terminate them if needed and have defensible, defendable actions that will stand up to workforce commission scrutiny if they decide to file unemployment.

                                  So when we’re looking at – and remember my caveat, I’m not that kind of doctor and I’m certainly not an attorney, so anything you hear, please go check it out with your trusted professional. The first part of a progressive discipline plan is going to talk about misconduct. This is just what bad is. It’s anything – if you don’t do what I say, if you don’t follow what’s in this policy and procedures, if you have to define it, how are you going to measure it? Immediate disciplinary action, well, that’s that awesome moment when you say no, no progressive plan for you, you’re done, hit the door. There are conditions when you can terminate immediately. Now, that doesn’t mean there won’t be repercussions. As I mentioned, when I do my coaching and consulting, don’t let that just tie your hands, like oh, I better not fire them, they may get mad at me, they may file a workforce complaint or whatever. It’s okay if you see them doing something egregious – it’s your business, I’ll go buy you a coffee mug that says “I’m the boss.” You are in charge, so make sure you put in your policy and procedures manual in your progressive discipline plan that there is conduct that is grounds for immediate disciplinary action.

                                  From there, everything sounds pretty familiar. You have verbal warnings, written warnings, and then, of course, you can have as many strikes as you’d like, ultimately leading to hey, it looks like this isn’t the best place for you to work and we’re going to invite you to go seek employment elsewhere because you’re no longer employed here. And then, of course, a signature page to put with the documentation.

                                  I mentioned one other important thing when I introduced this. This is a great way to layout orientation for keeping your employees HIPAA-compliant. One of the number one ways mental health practices fall out of compliance is trying to get new employees onboarded. So if you have a policy and procedures manual and it includes “all employees must be trained annually and provide a certificate for their HIPAA training and training on technology, etcetera, etcetera, that is going to lay the groundwork for an extremely compliant office that you can be proud of. 

                                  Alright, that’s it. That’s some of the paperwork and some of the systems that I use. Get your systems in place, in ship shape, and then get ready to launch or relaunch that practice in the community because they need you.

                                  Alright, let’s get to work.