Wednesday, October 17, 2012

On Therapy Pets

On one of my clinical psychology practice list serves, the question came up about whether any members used therapy pets in their private practices. One specific issue raised in the post was how to be sensitive to clients with animal allergies if you kept a pet in your office, which is, of course, a very legitimate concern.  I used to have a therapy pet in my office in San Antonio.  It was a Chinchilla named "Neo".  Chinchillas are pretty hypoallergenic so the issue of allergies wasn't especially relevant.  Plus, he lived in a cute cage shaped like a little house and we would only take him out when clients wanted to hold or pet him.  He was a great incentive for my teen aged clients to participate because getting to play with Neo became a great positive reinforcer.  However he was really messy so I ultimately found him a new home because cleaning up after him just became too time consuming.  I had a brightly colored little crate I carried him from home to office in.  He was well known at the supermarket and OfficeMax because I couldn't leave him in the car when I ran errands on my way home from work.  I'd put his crate in the seat of the shopping cart and we would run my errands together. 

In San Antonio, I had several clients who really liked bringing their dogs with them to therapy sessions.  Of course, this could potentially have been an issue for other clients coming in with dog allergies but this never came up.  Now that I live in Colorado, people seem to bring their dogs everywhere.  Even the bank has dog biscuits on the counter instead of lollipops for the people!  Every restaurant has a water bowl outside for the dogs who wait patiently for their owners while they eat.

For the first time in my career, I have a home based practice.  While my office is at the front of my home, it is still in my home.  I have a medium sized westie-poodle mix and two cats.  The cats hide under the bed when clients are here so they are obviously not willing to be therapy pets of any kind.  I was initially putting my dog in the mud room when clients came so they wouldn't be bothered.  Believe it or not, this really bothered my clients!  Every one of them wanted to meet my dog and didn't want my dog locked up on their account.  Now, my dog comes and greets them while they are waiting to see me.  She has become my pseudo-receptionist!  

I keep the dog out of my therapy office so she is not a distraction but if a client (particularly a teen) wanted her there, I would allow her in.  So far, I haven't raised the allergy issue with new clients although I do tell them that my office is in my home before they schedule their first appointment.  So far, everyone seems to assume that I have a dog.  Many of them come with their dogs and leave them in the car in the shade with the windows open while we meet.  Occasionally their dog goes out in the yard to play with my dog.  Of course, this will probably change when it gets colder and snows.

I think this is all really ironic because I am a cat person and I can't quite believe I even have a dog.  I never expected her to be a business asset.  

When a new client brings up the allergy issue, I will offer them online psychotherapy instead.  A highly respected psychologist named Ken Pope, PhD, with whom I am acquainted, keeps therapy cats in his office.  When a potential client has a cat allergy he offers to see them in their home.  The Vail Valley is too spread out for me to offer that routinely but I would consider it as an option as well.

BTW, this all started with a fish tank.  I set up a pretty tank in my first private practice office because it was soothing.  However, I am really bad at keeping fish alive.  One day a particularly difficult 11 year old came in and in a hostile tone of voice said "your fish is dead."  I had just fed the fish a few minutes earlier and before I could stop myself I fired back "No he's not!"  But he was.  Then the kid said "You are traumatizing me with your dead fish."  And then we both cracked up.  I didn't replace the fish and I gave away the tank.  And then I got Neo the chinchilla (see first paragraph).

Twitter: @drjsquyres    Facebook: JillSquyresPhD

Not to be copied without written permission.
Text copyright 2012 by Jill Squyres, PhD.  All Rights Reserved

Sunday, October 7, 2012

Fast Forward: San Diego California Oct 5-6, 2012

I’m sipping a diet Dr. Pepper and enjoying the view from a window seat on a 737 flying over Utah. I’ve just spent the past few days in San Diego at The American Psychological Association’s Division 42 (Psychologists in Independent Practice) Fast Forward conference.  I attended this inaugural Fast Forward meeting for several reasons.  First and foremost, I am a relatively active member in this division and it’s a good opportunity to participate in the division I consider to be my professional “home”.  Also, psychologists need to get annual continuing education to maintain our licenses to practice.  This conference provided all the CEUs I require for the coming year for my psychology licenses in Colorado and Texas.  I also specifically decided to attend Fast Forward because I was asked to be a speed mentor at an innovative workshop put together by Dr. Heather Wittenberg, a dynamic and creative psychologist lucky enough to live on Maui.  I was honored by the invitation but also delighted to have the opportunity to share my expertise with early career psychologists.  I think the workshop exceeded everyone’s expectations and I hope Dr. Wittenberg feels considerable pride in her accomplishment.

Division 42 has an active and lively list serve that is a professional perk of membership.  Many prominent psychologists make frequent postings.  It’s ironic to feel like you know a colleague well when you’ve never actually met them in person.  This meeting was also appealing because it gave me the chance to get to know some of these delightful people face to face.  What a pleasure it was and, of course, the chance to network is always a nice benefit of attending a professional gathering. 

Over the past few days, I’ve listened to presentations that both inspired and sobered me.  I’ve discussed complex ethical issues and features of online and office based practice.  I was privy to fascinating dialogs regarding professional development and ways to think “outside the box” about the practice of psychology.  As a result, I’m contemplating new directions and strategies for my own practice.

I even won a great book in a raffle held during yesterday evening’s social hour: “Financial Success in Mental Health Practice” by Steve Walfish (who graciously autographed my copy) and Jeff Barnett.   That’s the second raffle prize I’ve won in the past few months.  It’s also the second raffle prize I’ve won in my whole life!  And both prizes were something that I could use and really wanted.  Lucky me! 

The food and fellowship were fantastic and the weather was perfect.  The meeting was held at the Rancho Bernardo Inn, which turned out to be an idyllic Southern California venue.   So far, our planes have been on time, our rental car was ready, there was little traffic and my iPhone’s navigation system guided us efficiently where ever we needed to go.    

On a personal note, my sister lives in the San Diego area, so not only did I get to attend Fast Forward, I got to spend several delightful days in her company.  It was also a chance for a whirlwind getaway with my husband who came along so we could enjoy some time together, visit with my sister, relax in sunny San Diego and meet some new friends.  We even got to do a little shopping, which is no longer as easy as it used to be, since we’ve left the “big city” of San Antonio and relocated to the small Colorado town of Eagle.  We are hoping our teenaged daughter will be delighted when we return home this evening with a lovely dress for her to wear to her first homecoming dance.

All in all, an extremely satisfactory few days, wouldn’t you say?

One of the most amusing things I learned at one of the presentations I attended at Fast Forward is that my cat, Pepper, is a "digital native."  Thanks Dr. Ofer Zur (http://www.zurinstitute.comfor the insight!

If you would like to learn more about me, take a look at my website:

Monday, October 1, 2012

Psychotherapy and Electronic Health Records (EHR) Q & A

EHR Q&A: Answers to Mental Health Practitioner’s Most Frequently Asked Questions
By Jill Squyres, PhD

Lately, there’s been a lot of buzz about electronic health records.  Here are answers to some of the most frequently asked questions about EHRs as they relate to mental health practice.

What’s the difference between an EHR and an EMR? What does this have to do with PII and PHI?
The digital age in health care requires us to keep track of a veritable alphabet soup of acronyms!  While the terms EHR and EMR are often used interchangeably, by the most stringent definition, EHR (Electronic Health Record) refers to all of a person’s health information maintained in an electronic format.  EMR (Electronic Medical Record) generally refers to a patient’s chart maintained by a health care practitioner or organization.  An electronic document that includes data entered by a health care provider as well as information added by the patient would be an EHR by this definition.  Many people are starting to use the term EMR to refer to both as a convenience because when typing in Microsoft Word, the spell check function automatically changes EHR to HER!  PII stands for personally identifiable information and PHI is protected health information, both of which are included in the EMR.  HIPAA guidelines require us to take careful security measures to protect PII and PHI.

Do mental health care practitioners have to use an EMR?
Currently, counselors and psychotherapists are not required to use EMRs.  However there are many benefits to an EMR that may outweigh any drawbacks.  Physicians currently have guidelines requiring them to adopt EMRs.    

I’ve heard the government will pay you a lot of money if you start using an EMR.  Is this true? 
Medicare and Medicaid have initiated an EHR (this is the term these programs use) adoption program that offers substantial cash incentives for meaningful use of electronic health records.  Detailed meaningful use criteria have been developed by Medicare and Medicaid.  At the present time, none of these criteria pertain to mental health practitioners so we are not eligible for these incentive payments.  However, mental health professional organizations, such as the American Psychological Association, are lobbying government agencies to have mental health care criteria included in the next stage of meaningful use incentives.

What are the benefits of using an EMR?
EMRs can make managing client documentation much easier and more convenient.  Most EMRs also include an entire suite of practice management tools including a scheduling calendar, billing module, and online insurance claim filing in addition to the standard chart.  Progress note templates and intake, assessment, and treatment planning forms are often included as well.  Of course, all documentation kept online saves paper, filing space and shredding costs.  Records requests can often be accommodated by faxing the documents directly from your practice computer, saving on mailing costs, paper and postage.  EMR developers are now adding integrated video conferencing modules to their software to make initiating online sessions a point and click option.  Online EMR’s offer the added convenience of being able to access your client’s chart and contact data from any device anywhere with internet access. 

If I use an EMR does it have to be online?
There are several different types of EMR software.  One type is stand-alone software that you load on to one personal computer.  This software does not require an internet connection and all of your data is stored on the single computer it’s loaded on.  Of course, frequent back-ups to a hard drive, data CD and / or a thumb drive will be necessary if you are using this type of system to protect against loss of all of your patient data.  From a HIPAA compliance standpoint, this type of system is the most secure, although a stand-alone computer can still be stolen or accessed by unauthorized personnel resulting in a data breach.  The risk of losing all of your data in a disaster or computer crash is an important consideration from a risk management stand-point as well.  While there are security issues to consider with web-based systems or online back-up, it is not acceptable professionally to lose all of your clients’ mental health care information because your computer died or you experienced a natural disaster or fire.

How do online EMRs work?
Online EMRs are generally accessed over the internet through a secure browser window.  Most will work with any browser software although some programs will only work on PCs, not Macs.  Traditionally, EMR software has not worked on tablets, PDAs or smartphones, however, many vendors are adding apps, which can be purchased for an additional charge, for convenient access on mobile devices. Large medical practices and hospitals often purchase software that is loaded onto a dedicated server which may be physically located on their premises but this is not an affordable option for private practitioners or small group practices.  This set-up allows for an online record that is only accessible to devices on the facility’s private network.

Can I be sure my online EMR is HIPAA compliant?
The developer of your software should provide documentation of their security measures and compliance with HIPAA standards.  Any browser window accessing an online EMR should have an address beginning with https: instead of the usual http.  Your EMR software vendor should also require you to sign a business contract attesting to their security measures for HIPAA compliance.

What about all of my paper notes?
Of course, you can keep all of your paper notes filed the same way you have traditionally kept them and start keeping records electronically from the date you implement your EMR.  Many clinicians purchase a scanner and scan in old records so the paper copies can be disposed of.  Most EMR software allows for easy uploading of paper documents.  Some clinicians even continue to write their notes on paper and then scan them into the client’s EMR when they close out the appointment.

I’m already spending a lot on running my practice.  Is it expensive to adopt and EMR?
There’s a lot of competition in the mental health electronic record market, which helps keep costs down.  For the most part, you will pay more for extra features like patient portals, billing features like automatic credit card payments and insurance filing, templates and state of the art interfaces.  The cost for most software is charged as a monthly fee although some companies charge an additional fee to get your account and data set up.  This set up fee can also include transferring data from old software to your new EMR, which may look expensive but can cost much less than paying someone hourly for data entry to get you up to speed.  The typical monthly cost ranges from $60 - $150 per month depending on what features and technical and administrative support you want from your software provider.  There are also free options, which are not specifically designed for mental health providers but can be easily adapted to our needs.

Twitter: @drjsquyres    Facebook: JillSquyresPhD

Not to be copied without written permission.
Text copyright 2012 by Jill Squyres, PhD.  All Rights Reserved