It has been a year and a half of running my private practice and I'm finally starting to get the hang of this insurance thing. I am a member of CAQH (Council for Affordable Health Care), which holds a large database insurance companies use to enroll clinicians onto their panels. I can now submit electronic claims online. I understand what a CPT code is. I know the code when services are rendered in my office, etc, etc... As a client, there is no need to know what the heck I'm talking about. All you need to know is I can now accept some insurance. I am currently in network with Blue Shield, Aetna and I'm in the pipeline for United Behavioral Health (UBH) and PacifiCare. Their representative said I'd be accepted in their networks by the end of June 2008. I recently applied to Blue Cross, and Value Options. (Unfortunately, Health Net is not accepting new clinicians at this time)
I was very fortunate that I had a thriving practice early on without being on any insurance panels. In fact, my office landlord said she went through over five renters that failed to start a practice, and she was surprised to see me with several clients so quickly. I acquired clients through previous professional relationships, through word of mouth referrals and some through Internet marketing. I could have continued in this direction, without insurance.
Many clinicians choose not to deal with insurance at all. I can see why, what a headache it all can be. In addition, it is very intimidating. Plus, many plans will provide out-of-network reimbursement so the clinician does not have to concerned with submitting claims. I thought about taking that route, especially since dealing with forms and big companies is by far not a strength of mine. However, I decided to take on the challenge. The main reason is I do not want people to spend hundreds of dollars on services that could be provided through their benefits. My goal is to provide excellent services, help people get better, meanwhile not place too much of a financial strain on my clients. Plus, if I did not accept insurance, I'd miss out on working with certain populations I enjoy, such as Stanford students. I value my services and need to cover overhead costs as well, so hopefully I can get even more insurance companies to pay me to work with you!
Thursday, May 22, 2008
Tuesday, April 22, 2008
Starlight Adolescent Center
As the rumors of the community treatment center (CTF) closing became a reality, there have been two articles featured on the front page the San Jose Mercury News exposing some of the problems in Starlight.
http://www.mercurynews.com//ci_8874174?IADID=Search-www.mercurynews.com-www.mercurynews.com
http://www.mercurynews.com/ci_8909940?source=most_emailed
These articles highlight citations from MHAP (mental health advocacy project) including an incident when a staff member accidentally broke a client’s arm.
As a former employee of Starlight, I’d like to comment on the articles.
I worked at Starlight for a year in 2006-2007 as a mental health clinician and rehab therapist. My position at Starlight was my biggest challenge in my career to date, even after working in NYC’s inner city schools and with families struggling with a terminal illness.
While a lot of the information in these articles is true, I don’t believe the public understands just how acute most of the youth in Starlight are. They end up in Starlight after every placement option has been exhausted. This includes foster homes with intensive wraparound services, level 9, 11, 12 and 14 group homes that have increasing levels of staff supervision and structure. They all exhibit severe enough self-harm and/or aggressive behaviors that present a serious safety risk to themselves and others. Regularly the teens try to hang themselves, cut themselves, attack each other, attack staff and set fires. In addition, most everyday objects are contraband because these things are often used as a weapon or to cut on themselves including pens, CD’s, shampoo, jewelry, etc. I had to remember not to staple my papers together or use a paperclip because they are perfect devices for self-cutting. When I did beauty activities with the girls, I had to keep a strict count on every bottle of nail polish. One time, I accidentally left a hand-mirror on the unit and within five minutes, one of the girls smashed it and tried to use the shards to cut herself.
People are often naive to believe that if we are kind enough, respectful enough or tough enough, kids won’t show this type of behavior. While more skilled staff members were able to prevent an incident or de-escalate a client, the behaviors of the youth were difficult to control. It was always interesting to observe a new, more naïve staff member believe that they could “rescue” the kids. The youth usually picked up on the staff’s naiveté and would take advantage of him/her.
However, while the clients presented tremendous challenges, myself and other staff members were able to form strong therapeutic alliances with them. We enjoyed working with them, playing games with them, sharing stories and watching them grow. Despite their extreme behaviors, we had strong empathy for these kids who were suffering from a severe mental illness and/or endured severe trauma. Many of them did make progress and it was fulfilling to see. Also, in my role as a Mental Health Clinician, I had the privilege to work with and get to know many of the parents and families of the youth. (See my previous blog entry “The Day the Voices Stopped” for one example)
Unfortunately, the system beat my coworkers and me down. While we were working with one of the most difficult populations, we were also expected to do the job of 3 people. We were bombarded with mounds of paperwork, treatment team meetings, case management, crisis interventions and responsibility for 3 full days of therapy groups. Even with very good time-management skills, it was unusual to work less than 55 hours. (Keep in mind this is 55 hours of high intensity, not a corporate setting)
Often we were scheduled to be in 2 or 3 places at the same time. Inevitably I got burnt out and so did everyone around me. Countless people were hired for that position and left in under two weeks, wasting company time and training $. I lasted in that position only 6 months and then transferred to a per diem position. While I was better qualified as a clinician and enjoyed that work, I was tired of being set-up to fail so I felt I had had little choice.
And this is where I believe was the biggest problem of Starlight Adolescent Center and most of the child-welfare system. Workers are set-up to do the job of the impossible with unmanageable workloads. Staff who choose not to leave often go into “survival mode” to keep up with the demands placed on them both physically and emotionally. Because of the difficulty to retain staff, there was almost always a shortage of manpower, which would force even higher workloads on those who were left. Also, youth counselors, the front-line workers, were often forced to work overtime in this high-stress environment. While most staff entered their job with good intentions, it is near impossible to be present and handle the most difficult youth of the state of California under such conditions. How could the company claim they provided excellent service if this is how workers felt? There were exceptional staff at Starlight that were able to handle circumstances that most people couldn’t dream of. I felt frustrated when I observed them to be unacknowledged and then given more work until they were forced to leave.
Starlight is closing due to state budget cuts and is now under scrutiny from the media. However, it took on a challenge most organizations could never do. While Starlight had some major holes in its management, the cases and circumstances were all extremely challenging. I hope the youth still there will find a placement that will lead to healing and at the very least, safety. Caring for these youth is no simple task. Social workers and others work very hard swimming upstream in a system that makes it challenging to do more that put little band-aids on a large open sore.
http://www.mercurynews.com//ci_8874174?IADID=Search-www.mercurynews.com-www.mercurynews.com
http://www.mercurynews.com/ci_8909940?source=most_emailed
These articles highlight citations from MHAP (mental health advocacy project) including an incident when a staff member accidentally broke a client’s arm.
As a former employee of Starlight, I’d like to comment on the articles.
I worked at Starlight for a year in 2006-2007 as a mental health clinician and rehab therapist. My position at Starlight was my biggest challenge in my career to date, even after working in NYC’s inner city schools and with families struggling with a terminal illness.
While a lot of the information in these articles is true, I don’t believe the public understands just how acute most of the youth in Starlight are. They end up in Starlight after every placement option has been exhausted. This includes foster homes with intensive wraparound services, level 9, 11, 12 and 14 group homes that have increasing levels of staff supervision and structure. They all exhibit severe enough self-harm and/or aggressive behaviors that present a serious safety risk to themselves and others. Regularly the teens try to hang themselves, cut themselves, attack each other, attack staff and set fires. In addition, most everyday objects are contraband because these things are often used as a weapon or to cut on themselves including pens, CD’s, shampoo, jewelry, etc. I had to remember not to staple my papers together or use a paperclip because they are perfect devices for self-cutting. When I did beauty activities with the girls, I had to keep a strict count on every bottle of nail polish. One time, I accidentally left a hand-mirror on the unit and within five minutes, one of the girls smashed it and tried to use the shards to cut herself.
People are often naive to believe that if we are kind enough, respectful enough or tough enough, kids won’t show this type of behavior. While more skilled staff members were able to prevent an incident or de-escalate a client, the behaviors of the youth were difficult to control. It was always interesting to observe a new, more naïve staff member believe that they could “rescue” the kids. The youth usually picked up on the staff’s naiveté and would take advantage of him/her.
However, while the clients presented tremendous challenges, myself and other staff members were able to form strong therapeutic alliances with them. We enjoyed working with them, playing games with them, sharing stories and watching them grow. Despite their extreme behaviors, we had strong empathy for these kids who were suffering from a severe mental illness and/or endured severe trauma. Many of them did make progress and it was fulfilling to see. Also, in my role as a Mental Health Clinician, I had the privilege to work with and get to know many of the parents and families of the youth. (See my previous blog entry “The Day the Voices Stopped” for one example)
Unfortunately, the system beat my coworkers and me down. While we were working with one of the most difficult populations, we were also expected to do the job of 3 people. We were bombarded with mounds of paperwork, treatment team meetings, case management, crisis interventions and responsibility for 3 full days of therapy groups. Even with very good time-management skills, it was unusual to work less than 55 hours. (Keep in mind this is 55 hours of high intensity, not a corporate setting)
Often we were scheduled to be in 2 or 3 places at the same time. Inevitably I got burnt out and so did everyone around me. Countless people were hired for that position and left in under two weeks, wasting company time and training $. I lasted in that position only 6 months and then transferred to a per diem position. While I was better qualified as a clinician and enjoyed that work, I was tired of being set-up to fail so I felt I had had little choice.
And this is where I believe was the biggest problem of Starlight Adolescent Center and most of the child-welfare system. Workers are set-up to do the job of the impossible with unmanageable workloads. Staff who choose not to leave often go into “survival mode” to keep up with the demands placed on them both physically and emotionally. Because of the difficulty to retain staff, there was almost always a shortage of manpower, which would force even higher workloads on those who were left. Also, youth counselors, the front-line workers, were often forced to work overtime in this high-stress environment. While most staff entered their job with good intentions, it is near impossible to be present and handle the most difficult youth of the state of California under such conditions. How could the company claim they provided excellent service if this is how workers felt? There were exceptional staff at Starlight that were able to handle circumstances that most people couldn’t dream of. I felt frustrated when I observed them to be unacknowledged and then given more work until they were forced to leave.
Starlight is closing due to state budget cuts and is now under scrutiny from the media. However, it took on a challenge most organizations could never do. While Starlight had some major holes in its management, the cases and circumstances were all extremely challenging. I hope the youth still there will find a placement that will lead to healing and at the very least, safety. Caring for these youth is no simple task. Social workers and others work very hard swimming upstream in a system that makes it challenging to do more that put little band-aids on a large open sore.
Tuesday, April 1, 2008
Fountain of Youth group excercise
Every week I facillitate a drama therapy group in an outpatient program for mentally ill adults. I endeavour to come up with creative ideas to help people connect and process issues experientially. This week I invited the clients to "drink" from a “fountain of youth” and embody their 10-year-old selves.
My idea was inspired by a movie called “The Kid”. In this movie Bruce Willis plays an emotionally stunted man about to celebrate his 40th birthday. Then his 8-year old self comes to visit him and changes his perspective on life. Initially he is angry and mean to his younger self, telling the boy what a loser and an embarrassment he is. The feelings are reciprocated when the boy sees his 40-year-old self and is upset with the choices he has made. For example, despite his tremendous wealth and status, his younger self is disappointed the grown self does not have a cool dog and a significant relationship.
Over time, his adult self learns to accept his younger self and appreciate him. He recognizes that his younger ego is there to teach him self-acceptance. Then he had a chance to go back in time to the playground and stand up to some bullies. He also comforted his child-self when he learned his mother had terminal cancer. His adult self consoled the child after his father yelled and criticized the child. He hugged the child and said ”Dad is just yelling because he is scared and doesn’t know how to raise you by himself.”
I found this scene touching and thought about my own life and what I would tell my younger self while I was going through difficult things while growing up. And I was inspired to translate this concept into a drama therapy activity…
This morning I shared with the group my inspiration and thoughts about how we can help and teach ourselves or learn from our past selves. I let the clients know that they are free to not participate in the activity at any time if the activity brings up any overwhelming feelings or trauma. It is important when working in such a powerful medium such as psychodrama that the clients feel safe to do what is comfortable. In addition, I have had the opportunity to work with these clients for several weeks and build a rapport. Finally, this program emphasizes community and the connection among the clients is strong and allows for an emotionally safe environment to participate in a potentially vulnerable activity.
I began the session with a guided imagery. Asking the clients to close their eyes and imagine themselves when they were 10 years old. I invited them to think about what was happening in their lives, with their family and who their friends were at time. Who was their best friend? How were they socially? Were they shy? Outgoing? How old were their brothers and sisters at that time? Were their parents alive? Together? Apart? I asked them to think about what they liked to do. What toys did they play with? What games did they play? I had them imagine themselves in their 10-year-old body and remember how that felt. I also asked them to think about what their worries were at that time and to remember how they handled their feelings. Did they allow themselves to cry for example? I asked them about what their hopes and dreams were at that time. What did they want to be when they grow up? How did they imagine their future family?
After the guided imagery I had the clients open their eyes and I passed out [pretend] cups filled with water from the fountain of youth. Once they drank the water [miming] they would embody their 10-year-old selves and mingle with each other as 10-year-olds.
The clients embraced the activity and took on the inflection of their voices and body language of their 10-year old selves. They talked about their parents, brothers and sisters and pets they had. They talked about getting in trouble and hating school. The girls thought the boys were gross. Some were shy and some were very bouncy and outgoing. They talked about their parents not being home sometimes and feeling lonely. They also talked about the fun things they did with their family like going shopping. One talked about what a brat her younger brother is and another talked about how old her teenage sister is.
I interacted with the group as an adult talking to children and they respected me as “the teacher”. After about 20 minutes in character, I gave the group new glasses of [pretend] water to drink to bring them back to their adult selves.
Then we discussed the experience and how it felt to embody their younger selves. They expressed mixed emotions. One client stated she got in touch with the sadness she felt at that time. She remembered not being able to express her emotions and hiding when she cried. Another client talked about a similar theme of pretending to be happy even when feeling sad and lonely. They discussed the cultural differences between themselves and their parents and their attitude towards therapy and showing feelings. Some only began to learn to accept feelings later in their life. Another client talked about how she enjoyed being 10 again, she “didn’t have a worry in the world” at that time. While as an adult, she is usually very shy and reserved, when she embodied her 10-year-old self; she was more talkative and playful. Some clients stated they had difficulty at first remembering being 10, but with the guided imagery, they were able to get in touch with that part of themselves and were surprised with what they remembered and felt.
I asked the group to think about what they would tell their younger self or how they could help their younger self if they could go back in time, just as Bruce Willis helped his younger self stand up to the bullies on the playground and how he comforted his younger self the moment he learned his mother was terminally ill. One of the main themes that came up was self-tolerance and accepting feelings as ok and normal. “I would have told my dad, I have a right to have these feelings”, one client stated.
As I wrapped up, I thanked the clients for trusting me to do this vulnerable exercise.
My idea was inspired by a movie called “The Kid”. In this movie Bruce Willis plays an emotionally stunted man about to celebrate his 40th birthday. Then his 8-year old self comes to visit him and changes his perspective on life. Initially he is angry and mean to his younger self, telling the boy what a loser and an embarrassment he is. The feelings are reciprocated when the boy sees his 40-year-old self and is upset with the choices he has made. For example, despite his tremendous wealth and status, his younger self is disappointed the grown self does not have a cool dog and a significant relationship.
Over time, his adult self learns to accept his younger self and appreciate him. He recognizes that his younger ego is there to teach him self-acceptance. Then he had a chance to go back in time to the playground and stand up to some bullies. He also comforted his child-self when he learned his mother had terminal cancer. His adult self consoled the child after his father yelled and criticized the child. He hugged the child and said ”Dad is just yelling because he is scared and doesn’t know how to raise you by himself.”
I found this scene touching and thought about my own life and what I would tell my younger self while I was going through difficult things while growing up. And I was inspired to translate this concept into a drama therapy activity…
This morning I shared with the group my inspiration and thoughts about how we can help and teach ourselves or learn from our past selves. I let the clients know that they are free to not participate in the activity at any time if the activity brings up any overwhelming feelings or trauma. It is important when working in such a powerful medium such as psychodrama that the clients feel safe to do what is comfortable. In addition, I have had the opportunity to work with these clients for several weeks and build a rapport. Finally, this program emphasizes community and the connection among the clients is strong and allows for an emotionally safe environment to participate in a potentially vulnerable activity.
I began the session with a guided imagery. Asking the clients to close their eyes and imagine themselves when they were 10 years old. I invited them to think about what was happening in their lives, with their family and who their friends were at time. Who was their best friend? How were they socially? Were they shy? Outgoing? How old were their brothers and sisters at that time? Were their parents alive? Together? Apart? I asked them to think about what they liked to do. What toys did they play with? What games did they play? I had them imagine themselves in their 10-year-old body and remember how that felt. I also asked them to think about what their worries were at that time and to remember how they handled their feelings. Did they allow themselves to cry for example? I asked them about what their hopes and dreams were at that time. What did they want to be when they grow up? How did they imagine their future family?
After the guided imagery I had the clients open their eyes and I passed out [pretend] cups filled with water from the fountain of youth. Once they drank the water [miming] they would embody their 10-year-old selves and mingle with each other as 10-year-olds.
The clients embraced the activity and took on the inflection of their voices and body language of their 10-year old selves. They talked about their parents, brothers and sisters and pets they had. They talked about getting in trouble and hating school. The girls thought the boys were gross. Some were shy and some were very bouncy and outgoing. They talked about their parents not being home sometimes and feeling lonely. They also talked about the fun things they did with their family like going shopping. One talked about what a brat her younger brother is and another talked about how old her teenage sister is.
I interacted with the group as an adult talking to children and they respected me as “the teacher”. After about 20 minutes in character, I gave the group new glasses of [pretend] water to drink to bring them back to their adult selves.
Then we discussed the experience and how it felt to embody their younger selves. They expressed mixed emotions. One client stated she got in touch with the sadness she felt at that time. She remembered not being able to express her emotions and hiding when she cried. Another client talked about a similar theme of pretending to be happy even when feeling sad and lonely. They discussed the cultural differences between themselves and their parents and their attitude towards therapy and showing feelings. Some only began to learn to accept feelings later in their life. Another client talked about how she enjoyed being 10 again, she “didn’t have a worry in the world” at that time. While as an adult, she is usually very shy and reserved, when she embodied her 10-year-old self; she was more talkative and playful. Some clients stated they had difficulty at first remembering being 10, but with the guided imagery, they were able to get in touch with that part of themselves and were surprised with what they remembered and felt.
I asked the group to think about what they would tell their younger self or how they could help their younger self if they could go back in time, just as Bruce Willis helped his younger self stand up to the bullies on the playground and how he comforted his younger self the moment he learned his mother was terminally ill. One of the main themes that came up was self-tolerance and accepting feelings as ok and normal. “I would have told my dad, I have a right to have these feelings”, one client stated.
As I wrapped up, I thanked the clients for trusting me to do this vulnerable exercise.
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