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  • 472 Transcript.

    [00:00:00] Dr. Sharp: Hello everyone and welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

    Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get 2 free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.

    This podcast is brought to you in part by PAR.

    Hey, guess what y’all, the BRIEF-A has been updated. The BRIEF2A is the latest update to the BRIEF2 family. Use the gold standard in executive functioning assessment to assess adult clients. You can preorder it now, visit parinc.com/products/brief2a.

    Hello everyone and welcome back [00:01:00] to The Testing Psychologist. Today is a business episode. I’ve got my guest, Carolyn Boldt. Carolyn is personally passionate about holistic health and wellness, and an outspoken advocate that the environment of your space impacts your success. That’s what we’re talking about today.

    With over 40 years of experience in the commercial interior industry, she holds a BS in Interior Architectural Design from the University of Texas, Austin, where I did an internship, incidentally. She is NCIDQ Certified, a Registered Designer, a LEED AP, and Professional Member of International Interior Design Association.

    In 2004, she and her husband, Scott, co-founded CrossFields as a design-build firm in Atlanta. In 2011, they changed their focus to expand the impact of holistic health by elevating the public’s image of alternative medicine through virtually creating outstanding healing environments nationwide.

    She loves to spend her time with her 8 wonderful grandchildren, involvement in church and community activities, traveling, and boating on [00:02:00] the lake with her husband.

    I really enjoyed my conversation with Carolyn. We are talking all about design. We’ve talked about design on the podcast before, but this is certainly a different episode because Carolyn engages in a live consultation with me while looking at photos of my personal office and our waiting area at my office so you will get a front-row seat to Carolyn’s thoughts on our space and get to hear some, like I said, live suggestions and ideas about how to improve the space that you can carry over to others, including your own, of course.

    This is a heavy visual component, as you can imagine. I think you can take a lot from the audio, but if you want to get the full experience, then I definitely recommend jumping over to the YouTube video on The Testing Psychologist YouTube channel and [00:03:00] watch that as well.

    Let’s get to my conversation with Carolyn Boldt.

    Carolyn, hey, welcome to the podcast.

    Carolyn: Hey, thanks for having me, Jeremy. I appreciate it.

    Dr. Sharp: Oh, yeah. I am excited to talk with you. We’re talking about design and how that is important for our businesses. This is a topic that we’ve talked about a little bit in the past, but it continues to be important.

    We’ve done a little update of our office space here over the last few months. I know there’s more to be done, but this is always something that needs to be top of mind for us as we grow our practices. So thanks for being here.

    Carolyn: Absolutely. Thank you.

    Dr. Sharp: Let’s start with the [00:04:00] question that I always start with, which is, why do you do this? Why is this important in your life? Why’d you choose it out of all the other things you could presumably be doing?

    Carolyn: You can presumably be doing. I’m an interior designer, interior architect. I think it chose me more than me chose it. And that I chose to do that when I was 14.

    My father worked for NASA and he was worked on the advanced preliminary design of the space station. An architect was working with them on the interior design of a zero-gravity earth-orbiting space station. He was younger and he would come over and visit with my father because he’s from Florida, they moved him to Houston for this project.

    They would sit and philosophize for hours about the theory of space, the psychology of space, how people react in [00:05:00] space and how space has an environment, it has a thing that happens to you depending on what’s going on around you. They would philosophize about it.

    I was interested in art and I was interested in people and I thought, hey, this was a good mix of the two, helping create environments that will help people be what they want to be in the environment. That’s how I got started in that.

    And then I went on to graduate, went to the University of Texas, ended up in Atlanta, was doing design and all over design and design build, et cetera, working for myself for years and then started working at Life University in 2003. That’s a chiropractic college here.

    Most of my project work was corporate offices and design and stuff but I got very immersed in the students and their aspirations to grow and become and be people in the [00:06:00] world with their visions so I began to learn a lot about the profession of chiropractic, and I was already a holistic patient. I’d already been under chiropractic care and then under functional medicine care, et cetera, more alternative care myself.

    As we got into working in the university, and when I say, we, my husband does construction. So we were doing design-build all over campus. In 2010-ish, they asked us to teach a class to the students on why your office environment matters. I got so excited. We did it purely gratis.

    I had already done one chiropractic office, an independent chiropractor that I bartered with. He was a student at my chiropractor and he said, hey, go bartered. So I did, and it was because he opened around the corner. So I fell in love with helping the more sole practitioner or the smaller [00:07:00] non-corporate as I’d always worked in corporate.

    So a whole bunch of little pieces all came together and it was like, hey, let’s help these doctors have more success in an area that they don’t know anything about and it’s their branding; their office is their branding. Their office is an extension of who they are.

    As we talked earlier, in corporate world, interior design, interior architecture is just an expectation. It’s just a piece of getting your office laid out correctly, getting it efficient and maximize the flow and then how you design it to meet your needs of your company, needs of whether it’s retail or hospitality or office and the smaller practitioners just don’t understand that.

    So we went on a mission to explain that and to teach that. And then out of that grew us designing offices all over the world because we do it virtually. [00:08:00] And then it went from chiropractic and it kept expanding. So we do all types of, I would call it more alternative medical practices, not straight medical as much as more alternative, but all types of. So that’s how we got into it, in 2010, 2011, somewhere in there.

    Dr. Sharp: That’s amazing. What a story. It sounds like a combination of early childhood stuff and then some personal experiences and going where the opportunity presents itself.

    Carolyn: It encompasses those three that all got woven together. Yes.

    Dr. Sharp: I’m super grateful. I end up talking to a lot of auxiliary professionals that are focused on healthcare professions from money management to design to websites to whatever. I’m so grateful that there are those of y’all out there who have chosen to focus on working with folks like us, because we do not get taught this stuff in graduate school. [00:09:00] I know there are a lot of offices out there that are not probably up to par. We need a lot of help when it comes to non-clinical stuff.

    Carolyn: Yeah. Well, it’s not what you study, like you say, you don’t study business when you’re in school, you study what it takes to get your license so you need to learn those other things. If you’re going to be in business for yourself, you’ve got to learn them outside. That’s what it’s all about. So that’s why your listeners are here, right?

    Dr. Sharp: I think so. I think that’s part of being a business owner is building these miniature skill sets where we have to know a little bit about design or at least know how to hire the right person. We need to know a little bit about marketing or hire the right person. Owning a business is wild. We can go down that path.

    Carolyn: Let’s not do that.

    Dr. Sharp: Let’s not do that. We can do that another time. People are excited to hear about the design component.

    A part of your [00:10:00] story stuck out to me. This should be a no-brainer, but I didn’t even think about how bigger entities or corporations have design as a matter of course in their business, it’s just a line item that has to be accounted for because it does make such a big difference at that scale. It’s interesting. It got me thinking about this should be integrated more into small business as well.

    Carolyn: It’s just like before people had websites. It’s like the only people that had websites a long time ago were the big corporations and they were basically a brochure of who they were. And now it’s become an important piece and they wouldn’t think about not having one. Now the small business owners understand that too. So it’s just a matter of helping them understand and be educated on that.

    Dr. Sharp: Great. Let’s dive into some of the [00:11:00] content here. I would love to start with maybe definition around what you call, what is included when you say design, architecture, how are those related? Let’s start there.

    Carolyn: Okay. We have to start there. What we start with is the idea of form follows function. What that means is that they’re totally interrelated. For those that can see me, my hands are all connected together.

    It’s not, hey, you get the space to function well and then you make it pretty, the form being the aesthetics. It has to think cohesively together but you’ve got to lead with function.

    So the very first thing that happens and a lot of practitioners understand this is that space needs to function well. Function well means that you need the right amount of space for what you’re doing. You don’t need to be too small or that impedes your efficiency and operation. If it’s too big, you’re [00:12:00] wasting space on rent. It’s just the right amount of space is a really key.

    A lot of practitioners don’t understand how much space they need. So we start there. How much space do you need? And then we start talking about how you practice and how you flow.

    Depending on the different types of practices, you might have patients in and out of your office on a regular basis. Chiropractors have high volume of patients in and out of their practice, but a practice like yourself will be more smaller and longer visit time.

    So how is that patient coming into the space? What are they experiencing when they first come into the space? How do they process through it? Functionally, everything’s where it needs to be, saves you time, saves you energy, lowers your operation cost.

    Dr. Sharp: Can I ask you a question?

    Carolyn: Yes.

    Dr. Sharp: I had a question about the space and the size specifically, [00:13:00] because people ask about this all the time, how much space do I need?

    I wrestle with this in terms of our waiting area, which we will talk about here in just a bit in a little bit of a live consult, which I’m excited for, but with our waiting area, it’s like, how much space do we need based on our practitioners and patient flow? Do you have any guidelines or rules or rubrics or anything like that that are easy for folks to understand if they’re considering just size of a space?

    Carolyn: There are. We call them guideline formulas. Let me walk through a lobby real quick; a lobby waiting space.

    What you want to think about is how many people do you want to seat in your waiting area? And then that times a certain square footage will tell you how much space you need for the waiting. That certain square footage depends on how you want them to be seated in the space.

    [00:14:00] I already have seen your space. You have sofas in your space. So that is more square footage per person. So if you want a sofa, a living room, you need about 35 square feet per person that’s going to be in that space.

    If you’re going to be in what I’m going to call more of a high density, imagine just rows of chairs, that’s going to be the lowest square footage, the smaller the chair, the lower the square footage. So you can get down to 15 square feet per person, but there is a minimum. You don’t want just 15 square feet for one person, because that’s not really enough. So there’s some guidelines on that.

    We start with that; how many people do you want to seat in your lobby? And that usually has to do with how your patient flow is going to be, because if you’re seeing one person, would you see one person an hour or a family an hour so, but your lobby serves more than just you. So that’s a different thing.

    So how many people are you going to [00:15:00] serve in an hour is a good rule of thumb for how many people you need, just thinking of them flowing through and where they are going to be. So that’s how most people process through it in operation.

    And then it’s how many feet per person and then you’ve got some kind of front desk. It depends on how many people are going to be behind your front desk. A good rule of thumb is 50 square feet per person.

    So if you’ve got 1 person, approximately 50 square feet. A 6 by 8 area is a pretty typical work area, that’s that 50 square feet. So that’s a good rule of thumb. A larger practice may have multiple people behind a front desk and that just keeps multiplying out.

    So you start there. Let’s just say you have that all figured out. And then you look at, do you have a hospitality area? Do you have a retail area? Do you have a kid’s waiting [00:16:00] area specifically for kids? And then you have so many square feet per child depending on, is it really active play?

    If you’re a pediatric therapist, you’re going to have probably a good size playroom while those kids are waiting, or you don’t want to wait too long and you have that in your office. So you just have to work through it. You start with your list of what you’re trying to do and then there are formulas and calculations to do that.

    We have some resources on our website called Planning Your Office that we go through square footages. The next thing you do, though, is you add up all those square footages, and you’ve got to have circulation and exit and things like that. So you add about 40% to get your circulation space. You see how that kind of starts to add up there.

    Dr. Sharp: Oh, sure.

    Carolyn: I don’t know physically how large, I know I looked at your lobby, but I never asked you how big it was. We didn’t focus on that but that’s how [00:17:00] you come up with it. How many square feet you come up with? There is some calculation.

    Dr. Sharp: I love this. Our audience is pretty data-driven and metric-driven, and just knowing that there are formulas like this to consider. Personally speaking, I’ve never used anything like that in trying to design any space I’ve rented or put together. So that’s great information to have off the top of your head.

    Carolyn: Yeah. Ultimately, it’s how does the furniture and the equipment layout into the space. There’s rules around that too.

    Dr. Sharp: Okay. I’m trying to save some of this for our live consult portion of the interview here, but this is good for people to know. We’ll make sure to put the resource in the show notes as well, the link to your website, if folks want to go check that out and try to get a better idea.

    Going back to this [00:18:00] form follows function idea, so you’re looking at how the space is laid out first and then doing the design on top of that. Is that right?

    Carolyn: Yes, only as a designer where we can’t separate the two. So the design integrates into it, is what I’m saying, more than on top of. That’s hard to explain to people unless you’re in it and doing it but as you think about flowing through a space, as a designer, they think about it three dimensionally and how is that feeling to the person that’s going through it? So it has to both work.

    The flow has to work and then the aesthetics and the feeling, because the aesthetics are not just paint on the wall and some art, some pictures, it’s like the ceiling, the lighting, the change of textures and all kinds of elements that as you move through space, create different emotions because it’s all about [00:19:00] creating emotions in your patients. Choosing the emotions you want in your patients is the big thing.

    Dr. Sharp: I feel like the example that many of us have probably heard about, whether it’s an urban legend or not, is the casinos in Vegas and how the layout and design are meant to elicit certain behaviors and feelings and things like that. Is there legitimacy to that whole story?

    Carolyn: Oh, yeah. Very much so. There’s a psychology of space. Let me give you a psychology of space that a lot of people can relate to. Think about when you first enter a space, we think about retail design, because retail design is your first impression and people buy first with their eyes.

    You know that if you’re doing any marketing, that if people are going to find you and they find you on the website, they need to like what they [00:20:00] see right away. They need to find what they want unless they’re coming from a referral and then they’ll dig through everything to figure it out but if they don’t know you from Adam, it’s how you show up initially.

    If you’re working and you’re spending money to show up beautifully on a website, when they walk in the door, there needs to be a congruency to that to happen, do you follow me? And the same thing, even if it’s a referral, if you have someone refer you, they’re going to refer you if they feel proud about it.

    We’ve seen people that do facelifts that get an amazing increase in referrals from patients that have been with them forever, because all of a sudden the patients are proud of the space. Kind of digress, if we think about spaces, the first thing you want to do is you want to know who is your ideal patient and then secondly, how do you want to show up to them? How do you want to be their solution?

    It’s emotional words. It’s like [00:21:00] I want to be a safe place for them. I want to get them to be calm. You’re not trying to be a gym and create all kinds of energy; you want them to be calm. You want them to be focused. So creating that environment for that to happen can support what you’re trying to do. So it can support your whole practice.

    Dr. Sharp: Yes.

    Carolyn: I think about two retail spaces I’m going to bring to mind. This is no criticism for Walmart because Walmart makes a lot of money, but Walmart is very intentionally designed to be the low-priced leader, everything about it.

    When you walk into Walmart, you feel like you’re going to get a deal. The lights are bright. The surfaces are [00:22:00] hard. There’s stuff everywhere. There’s lots of stimulation, lots of words, lots of advertisements, lots of things going on.

    It doesn’t matter if the shelves are really neat; you’re still going to dig for a deal. It’s a whole psychology that supports that. I’m in one level up from a garage sale of sorts. It’s not that much, but if Walmart tried to upscale, people would not feel like they’re getting the deal. If they did anything in their spaces, so they support that in everything that they do. It’s bare-bones of sorts.

    Now, you go all the way to a high-end designer store, maybe a purse store. You walk in, the light levels different. You don’t see signs. It’s hard to find the price. It’s one item at a time. It’s more like an art gallery. And so it creates a different [00:23:00] expectation of what that client or that patron or whoever it is, who’s going into that store to buy.

    If they walked into Walmart and it looked like that, they would not feel like they’re getting a deal but if they walked into the high designer store, and it looked like Walmart, they probably walk out because they’re there for a different reason. So you follow what I’m saying.

    I’m not saying you need to be Walmart, I’m not saying you need the high-end designer store, but most practitioners need to be somewhere in the middle and they need to know who their ideal patient is, and that’s the key. And then the design is driven from that.

    Dr. Sharp: I got you. So taking that example and applying it to our field, are there equivalents that you found in your work with healthcare folks for maybe not Walmart, nobody wants to say, hey, we’re a commodity-based healthcare business where we’re just trying to give people the best deal, but I’m guessing there is some kind of equivalent agency? [00:24:00] Do you work with healthcare folks who are more who are more like Walmart versus a high-end art gallery?

    Carolyn: I don’t work with them, but I’ve had conversations with therapists about them that they don’t want to show up like the state board health examiners’ offices and things of that sort, if you follow what I’m saying, where it’s very institutionalized, do you know what I’m talking about? Inside of a more of a controlled environment. Those spaces feel that way.

    I’m not sure how people open up except they don’t have any other choice at that point to open up. I am stereotyping. I know every state health care agency there is out there, but you know what I’m saying, that has come up with therapists.

    I think of one in particular, [00:25:00] because I feel like I look like a state healthcare agency. The thing is he did work with people that were coming out of the system and things of that sort, so he couldn’t be too blue flu because he needed to support them but he also worked with some executives that he needed to find a balance between the two and not make it feel, it had to be comfortable for both, which is a little bit hard to do.

    You find where your ideal client is, and you try to go there and that allows a little bit on both sides to be okay with it. Do you know what I’m saying?

    Dr. Sharp: Sure. That seems like a wide range to accommodate.

    Carolyn: Yeah, it was.

    Dr. Sharp: I think this is important though, just to spend some time on this because I consult with folks building their practices who will put a lot of energy into their [00:26:00] website, especially these days, it’s easy to build a website that looks pretty good with all the tools out there, but then you get to the pictures of the office and it does not match. It sounds like you’re saying that consumers will pick up on that and it creates a little dissonance that doesn’t work in our favor.

    Carolyn: It’s hard to find pictures of offices on websites a lot of times. I know that more people are doing videos of people in their office where it’s focused on the people and not, which is great. You’re seeing people. You’re seeing stuff and that’s probably more important than architectural.

    On our portfolio, it’s all architectural pictures like you would see in a magazine. There’s not people in them. It’s what we do, but was saying that when we do an office and we have professional pictures made, our doctors do put those pictures on their website and it does [00:27:00] help people go, wow. That’s something interesting or impressive.

    It’s more about when the people walked into the office after they’ve seen this website. They’ve seen this wonderful, well-designed, modern, clean website, and they walk into something that’s totally disconnected.

    Especially a new patient, it doesn’t mean that you’re not going to have that patient stay or sell or anything like that, but it’s so much harder to sell them because you’re going to go upstream instead of them walking in and going, wow. This is comfortable. This makes me feel like I’m feeling atmosphere.

    Dr. Sharp: Absolutely. Maybe we talk about some specific ideas and then we can get into my own office consultation.

    Carolyn: Yeah, that’ll be fun.

    Dr. Sharp: I’m scared [00:28:00] of, to be honest. Generally speaking, function-wise, let’s lay out function, are there some general principles that you could say, hey, this is best if folks are thinking about how to lay out their office space, or is it truly space-dependent?

    Carolyn: It’s practice-dependent more than space-dependent. There are some certain rules though. If you’ve got a lot of people moving through the space, one of the rules that we have is that all of your hallways are 5 feet wide. One of the reasons that is, is because if your hallways are, if they’re 5 feet wide, you’ve met all handicap accessibility codes. You don’t have to worry about it.

    You can go down to about 4, 6 and still do that but if they get any less than 5 [00:29:00] feet, we found that 2 people passing in the hallway, 1 has to stop. Think about over time, it could add up to 10 or 15 minutes and say you’re a practitioner, you see patients, you see them in 10 to 15-minute increments, that’s 1 or 2 patients a day that you can add to your practice, just in volume.

    That’s a mentality, the higher the volume. A lower volume practice also has to do with, are you escorting the patient through or is the patient escorting themselves? I don’t know how you practice, but do you come out and get your people and have them come back?

    Dr. Sharp: We do.

    Carolyn: That’s a different thing. The space is important, but I’d say it’s more important in your specific office or all your things that you need easy for you to get [00:30:00] to and that kind of efficiency not as much the size of the room as the way that the furniture inside is laid out. Does that make sense? It’s very specific to the practice.

    Dr. Sharp: Yes. Just an observation, you keep coming back to the practice and using words like ideal customer and practice dependent. We have to put some thought into what environment we’re trying to create.

    It feels like branding almost more than anything.

    Carolyn: Oh, it’s exactly branding. It is branding, 100%. It’s an extension of your branding very much. In fact, if you’ve gone through any kind of branding exercise with any kind of graphics person that really goes into the fullness of your brand, not just, hey, I’m going to give you a [00:31:00] logo, but the fullness of how you’re going to show up, they’re asking the same questions that we ask.

    Dr. Sharp: That’s fascinating.

    Carolyn: Ideally, when they come to us, they’ve actually gone through both parts. A lot of people that come to us are moving offices or opening offices, and it’s an opportunity to do some rebranding finishes.

    Dr. Sharp: So it’s a side question then, is it helpful if people come with a solid brand identity? In an ideal world, would you like someone to come with their brand assets all ready to go?

    Carolyn: If they come to us with their brand assets already done, then we can complement it and keep going. So we basically charge by the hour and we charge based on historical data, how big the square footage is, what kind of [00:32:00] project it is, et cetera but we have a range and that range varies more because of the client than it does for anything.

    So a client that’s already gone through the branding process, we find is already very decisive and they’re very clear. They already have a vision, but we’re also very gifted at pulling out that vision. So we have clients that come to us and we spend the time pulling out the vision.

    For example, people, we ask them to put together a vision board for us that has to do with the space, not their brand, but their space and you’ll see them that they are all consistent. They know their brand. They know what they’re going after. All the pictures are consistent.

    And then you’ll see them where they’re all over the place. The spaces go from super modern to country [00:33:00] farmhouse to different styles, different things. And so those are the ones that that’s part of our gifting is to work through and help figure out what is it that you like about these spaces and how does that match with who you want to show up as?

    Because the other thing about it, we talked about this earlier, is that commercial design is not a luxury. Residential design is more of a luxury. Residential design is very much about the human being and the person and trying to create a space for them, which is wonderful and lovely, but it’s their favorite stuff. Your office should be your ideal client’s favorite stuff, not yours.

    And not that it’s always different, it’s not because it’s who you are and who you show up. I think of an example of someone who really love the color red. He just loves red, but he was trying to create this really soothing environment [00:34:00] and it didn’t work together. So it’s like how do you do that? Let your car be red and let’s go do something different in your environment.

    Dr. Sharp: Yes. I’m glad you brought that up. Personally speaking, I feel like that is a problem that I’ve really wrestled with because I’m the owner of our practice. I set the tone for our design and so forth. I know my personal preferences really well, and it’s been hard to be flexible with that.

    I just want the office to look exactly like I want it to look and maybe that’s what the client wants, maybe not. Anyway, I’m just thinking out loud and I’m guessing some other practice owners run into that too.

    Carolyn: If your clients are very similar to you, then you’re probably right on.

    Dr. Sharp: That’s a great question. I’m not sure, we can talk about that as we go along. Yes. [00:35:00] That’s important to point that out, I’m guessing, for other owners.

    Carolyn: It is. And being careful what you like.

    Dr. Sharp: Sure.

    Carolyn: I’ll give you a good example. You’re a therapist. You don’t want an office that looks like it’s space age. You just don’t want to because that’s not familiar. You need to create familiarity in a therapy office. Do you know what I’m saying?

    If you are if you’re creating cutting-edge, state-of-the-art, regenerative medicine type stuff, yeah, look like your space age because people will walk in. So do you follow what I’m saying? It’s like what are you offering in your practice?

    Dr. Sharp: Yes. That’s fair. I have so many questions. Honestly, I’m just verbalizing. It’s so hard to choose what to talk about because I have so many questions with us. I’ll pick one though, and this may be an obvious question, but I [00:36:00] would love to hear you reflect on any geographical differences that you may have found. Do you see different trends based on city versus rural or Midwest versus Coastal? I’m curious about bigger patterns and design and layout.

    Carolyn: All of those things you said, we almost call them as styles. So yes, there’s a big city style. It gets more trendy. It’s keeping up with the Joneses’s feeling. It’s very much more like what’s the next and newest thing that’s out there to be.

    It can be trendy. Trendy, meaning that there’s design, they date, things can come and go. So the trendy of something is the faster it dates, the less trendy it is, the longer it dates [00:37:00] but that can be okay in the city because they’re competing with all the retail that are trendy and all the other people that are trendy.

    And that’s another thing; how do you want to show up compared to your competition? How do you want to be known for? Yes, there’s a general, it’s not absolute, but there’s a generality of a big city and a generality of a country. As soon as I say that to you, you see different pictures in your head, right?

    Dr. Sharp: Yes.

    Carolyn: There definitely is a difference in what we would call Florida versus Seattle. Seattle has a coast too, but there’s a difference in it and how it feels. We think about how people dress and what they wear.

    I was working with a doctor that we’re building offices around the country and the ones up North, we have to have a vestibule. We have to have a place for people to take off their galoshes and they have to, you know what I’m [00:38:00] saying?

    It’s a different but people live that way and that’s what has to be taken care of. It’s very different than having one that you can open up the whole front and have people be part of the experience all the time or a big part of the time. Does that help?

    Dr. Sharp: Absolutely. I appreciate you indulging some of these questions. We’ve talked about, are there basic principles to guide the layout. And you said it was practice-dependent, which is great. Are there basic principles to guide the design; the form for a space, or again, is it practice-dependent?

    Let’s take a break to hear from our featured partner.

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    Carolyn: In design, you start with what is your end goal? What are you trying to do? What do you gather from all of the intake that you have with your client? And then depending on that, in design, we have what we call principles of design, and then we have elements of design. Principles are what we follow to have good design. We’re going to talk about some of those in [00:41:00] your lobby.

    They have to do with things being proportion, things being balanced. To have it be good design, you need to basically meet these principles. So that’s over here, but then the elements are the ones that create different emotions.

    I’ll give you an example. We were talking about horizontal lines make people want to be comfortable and sit down, vertical lines make people want to stand up, a perfect curve creates community, like a circle, a much more geometric and then a whimsical curve or whimsical shape creates more melancholy fun laughter. Just the use of lines in the way that things are styled [00:42:00] can change an emotion.

    The same thing with the shape, a big psychology is textures and another huge psychology is color. There’s a huge psychology of color. And then the other thing is light. So light levels can change energy immediately. We know that natural light creates an energetic healing feeling and then low dark light creates, it’s your body, it’s how your body reacts to light. You can use it or not.

    We talk about quality design is not expensive. It can be really expensive, but it doesn’t have to be expensive at all. It just has to be well-thought through and looking at all the different principles and then the use of the different elements [00:43:00] that are, paint is the cheapest thing you can do and it can create the most impact. We use variations in paint to create drama or to create energy or to create quietness or whatever just throughout an office.

    Dr. Sharp: That’s fantastic. I’m going to double-click on two of those things. So color real quick. I think we all have heard don’t do anything with red. You said that, don’t do anything with red.

    Carolyn: So when I say don’t do anything with red, red is very intense. Red creates energy. It can raise your heart rate and they can see that. So you have to be intentional about it. So if you are creating an environment that you want, you’re probably not doing this as a therapist, but if you’re creating an environment that you do want a lot of energy, [00:44:00] or if you want a lot of power, the red tie creates just enough red. So what is the image you’re trying to get across?

    I do a whole class on color theory, but let me say blue is a very calming color. You take the color wheel, I don’t know how far we want to go with this, but everybody knows the color wheel. We did this. You start with the 3 main colors that you can’t mix, you’ve got red, you’ve got yellow, and you’ve got blue. You can’t mix anything to get that.

    Each one of those are the main you, and then you start to mix them together and you get secondary colors and tertiary colors, et cetera. So color is infinite, but the general base color, we call the you, so the base color of yellow is a memory. That’s why you use yellow highlighters and yellow legal pads. It invokes memory.

    We’re going to talk about that in your office, [00:45:00] it has warmth to it. So you take the color wheel and you have warm side and you have the cool side. So the yellow is on the warm side, the orange is on the warm side, the red is on the warm side.

    And then you go to the other side, the blue and the green are on there. You have purple, and it depends on how much red or blue is in the purple, on how warm or cold it is. It calms you down on the cool sides versus warms you up and gets you energetic on the warm side. That’s as basic as it gets.

    Then you go into the intensity of color; how bright it is versus how doled out it is, which is what happens when you mix the opposite colors on a color wheel. So you end up with brown Easter egg color, that everything ends up brown when you mix all things together, Easter egg water.

    And then you have what’s called value. So that’s adding white to a color [00:46:00] or adding black to a color. So you can take a color, let’s call it orange and you can add white to it and it becomes peach, it becomes feminine, light and airy. You can add black to it and it becomes a rust. It becomes more masculine. That’s psychology in a moment’s notice.

    Dr. Sharp: I love it. The other component I wanted to ask about too, is the lighting. I think a lot of us probably struggle with lighting because we’re in spaces that have overhead fluorescent lighting. Can we say a little bit about that?

    And that’s going to pop up as we look at our waiting area, because that’s our situation but is there anything to say on a basic level about how to deal with fluorescent lighting in an office space?

    Carolyn: Fluorescent lighting, first off, the newer offices don’t even have fluorescent, [00:47:00] they have LED, but it’s still the idea of a wash of light. So you get into a typical office building, it has 2×2 ceiling, and then it has 2×4 fixtures in there, and that is the cheapest lights you can get to get an overall wash of light.

    So that’s just what it is; what you’re trying to do. Understand that you need a certain amount of brightness in your area to clean it well but you don’t want this overall wash of light in a typical therapist office. I know you have other doctors who work with you, but you typically don’t want that wash of light. You want a variation of light.

    So the way you get a variation of light is if you’re fortunate to do can lighting, it can create a variation of light. Another way to do lighting overhead is to do track lighting and track lighting creates like the opportunity to have a variation of light, if [00:48:00] you’re following me.

    If you can’t change architecturally your lighting, what you do is you turn off your lights and you put lamps. I think you did that in your office. I saw that when we looked at your pictures quickly, which we’re going to talk about in a minute. The lamps create that home comfortable variation of light color. You can do uplighting, you can get enough light in the room, you just don’t want to wash of light unless you want to feel like you’re in Walmart or on offer.

    Dr. Sharp: It sounds fair. Okay. Oh, absolutely. This is fantastic. Like I said, I could ask a million questions about this stuff. I’m just fascinated by this material, but I think we’ve probably teased folks long enough. I would love to dive into this little experiment that we’re going to call a live consult.

    Just for some background for [00:49:00] the listeners, I sent Carolyn some pictures of our waiting area to check out ahead of time. I’m going to pull those up on a screen share here. So if you’re not watching the video, absolutely go check out the video. We will do our best to describe what we’re seeing, but I think the video is going to bring it to life more than anything.

    Carolyn: And you also sent your office. Let’s start with your office because a lot of people have offices and there’s not as much I would say to do there as there is in your lobby, so why would you start there? So we start on a what works beautifully here and go from there.

    Dr. Sharp: Yeah, that sounds great. So let me get everything set up here and we will start this screen share. All right, hopefully this is showing up. Can you see this okay, Carolyn?

    Carolyn: I can.

    Dr. Sharp: All right. [00:50:00] What we have here is my personal office. I will let you take it from here and just hold my breath and see what happens.

    Carolyn: So what I’m going to comment on is overall, it immediately feels warm and cozy. For those of you that can’t see it, it’s basically neutral colored walls. It’s a topi off whitish color, and then the sofa is gray, a little bit cooler next to the warm wall, which works beautifully, blends nicely.

    And then the rug is a little bit grayer, a little bit darker and the carpet is in between the two so it all blends together. The rug has some wonderful texture. It’s a fluffy rug, which feels more homey, not to commercialize.

    It’s got two, they don’t slide back or anything, but they’re two comfortable contemporary [00:51:00] chairs that look comfortable, but they’re small and feels like you could want to come in and want to sit in any one of those places. I’m sure that you have people sit in all of them.

    In the therapist’s office, where the people come in and sit is obviously extremely important because you need them to be comfortable and you’ve got a nice, comfortable, solid surface. You’ve got all of your textures. All of your colors tend to be more monochromatic and the bookcase and everything and then you have this wonderful little pop of yellow.

    We talked about yellow having a softness and a memory and just an energy to it, but it’s just enough. And then the picture above your sofa also has some fun color in it. There is a tiny bit of yellow. It’s got the blues, a little bit of red.

    What I commented on is I noticed immediately the height of your picture was what I would consider perfect for what you have in the room, because it’s lower. [00:52:00] I think it’s probably at or lower than most people’s eye level.

    What you want to do is when your pictures in your room, anything in your space, if you’ve got a lot of interest up high, people want to stand up; if you lower the interest, you lower the eye level, people want to sit down.

    Usually a picture is hung around 60 inches above the floor. If you go above that, it’s great for a lobby, but you don’t want to go too high. And then if you go below that like even down to 54 inches or so, people want to sit down.

    I know a lot of it has to do with how tall people are in their eye level, but the average person, let’s call them 5 feet and 6 inches, and so the 5-foot level fits there. So you’ve done that well.

    And then the other thing you’ve done is instead of hanging pictures all over the wall, you’ve tilted them, so it creates an artistic look to them where they’re sitting on the case and they’re leaning up against the wall [00:53:00] and you buried them nicely.

    The only thing I would say is that probably when you have a series of pictures on the wall, you want them to either have perfectly, they’re all the same size and they have a rhythm or you want to get them closer together and create what we call a composite.

    So the only thing I’d probably tell you to do is take the pictures that are against your window and probably get them closer together so they feel a little bit more like they’re one piece instead of three pieces because if you have too many places of interest, it gets too busy for people to pay attention to.

    So what I see immediately is the picture above the wall and that little splash of yellow. I bet people come and sit at your sofa first, do they?

    Dr. Sharp: Oh, for sure.

    Carolyn: Yeah. Even more because it’s just a drawing thing. Then the other thing you have in the corner, you have your desk. I don’t know if [00:54:00] you change it when people come in, but you want to avoid people seeing clutter, if you can do anything. I don’t see a lot of clutter, but maybe you may have just taken it for me and not thought about how it is when people come in.

    Then the only other thing is make sure all your blinds are even, you see how uneven your blinds are?

    Dr. Sharp: I saw that as we started talking, I’m like, oh no, these blinds.

    Carolyn: One of the things you did is you’ve turned off your fluorescent lights. You don’t have those on at all, do you?

    Dr. Sharp: No.

    Carolyn: Do you just have the one lamp or do you have one on the other side of the sofa too?

    Dr. Sharp: Yeah, there’s another one on the other side of the sofa.

    Carolyn: That’s probably enough light for you, especially when you have the windows open, maybe it might get dark so you might want to add two up lights in the corners on the other side of the room if you ever needed it, but I’m going to tell you, I wouldn’t do anything different in this office. So I want to say that.

    Dr. Sharp: That means a [00:55:00] lot. I’m going to go home and tell my wife that my office is great.

    Carolyn: Your office is great. I may have one more thing. Think about when you have lots of little things, how do you create a composite? Instead of just sticking one here, one there, just even pulling them closer together or getting a tray and putting them on makes them feel more unified than just lots of little things.

    Dr. Sharp: Sure.

    Carolyn: Just a decorator thing. I can’t even exactly tell what’s underneath that. It may be things you use in therapy. Are they?

    Dr. Sharp: Oh, yeah, are you looking underneath the table?

    Carolyn: Yeah, I’m looking there.

    Dr. Sharp: Yes. For those of you who are just listening, I have a glass-top table and then it has a little shelf underneath right above the floor. I have a bunch of toys and fidgets just sitting on the little shelf part. Yeah, you’re totally right, it could easily aggregate all that and [00:56:00] just put it in a tray or a bowl or something like that too.

    Carolyn: From a decorator standpoint, I would but then as a practitioner, they may feel inclined to touch it more if they’re not altogether. So you might want to experiment with that to see which one’s more important. It’s not totally like oh, this is horrible, but if I was walking in your office during staging, I’d pull all that together and bring it together.

    Dr. Sharp: Nice.

    Carolyn: There we go.

    Dr. Sharp: Let me ask you one question, this is great, I really appreciate it. My question is, when you say picture height and you said 60 inches, this is a very detailed question, but does that mean the top of the picture should be 60 inches?

    Carolyn: I’m sorry, it’s 60 inches to the middle of the picture.

    Dr. Sharp: Okay, great.

    Carolyn: So from the floor to the middle of the picture, typically at 60 inches.

    Dr. Sharp: Okay. That in itself is such a valuable piece of information.

    Carolyn: Or if you have a composite of pictures, the middle of that [00:57:00] composite at 60 inches is the most.

    Dr. Sharp: Great.

    Carolyn: You’ll have to measure it and tell me where it really is. I’m looking at a photo, it has its normal distortions of a photo would have, a wide angle lens type liquid so I’m not exactly sure, but it does not feel too high.

    Dr. Sharp: Nice. I’m just looking at the photo myself to see if there’s anything else I wanted to ask about but this is good. If it’s not catching your attention as something to fix, I will let it ride.

    Carolyn: No, I think overall, it’s good.

    Dr. Sharp: Great. So in that case then, let’s go to our waiting area. This is the first photo of our waiting area. And this is taken from the perspective, it’s not exactly when you walk through the door, but it’s just to the side of our entryway. So this is pretty close to what people see [00:58:00] when they walk into our waiting area. You can maybe describe it based on what you’re seeing.

    Carolyn: It’s about 16 feet wide. Is it square? It looks very rectangular in this picture.

    Dr. Sharp: It’s deeper than it is wide. So it’s definitely further back. It’s a bit of a rectangle. This is a wide angle, so it’s a little bit distorted, but it’s further back than it is wide.

    Carolyn: Overall, it’s a neutral color. It has the same kind of gray color as the floor, a warmer color. The sofas are definitely a cool gray and there’s that touch of yellow in a pillow and a throw. And then it looks like a little table and [00:59:00] a piece of art.

    And then there is a, what I’m going to call the front desk, and it looks like a modular piece that’s open and slabs and things like that are happening. And then in the far back straight across looks like a sink hospitality bar type of effect. I’m assuming there’s a hallway on the left that goes down. Is that where you’d go down to your offices and stuff?

    Dr. Sharp: Yes.

    Carolyn: I would tell you that, when you walk in there is no wall. I’m going to be critical now. I walk in, there is no wall. You walk in, you’re in the middle of a room. You know that there are sofas. There’s two sofas lined up on the right-handed side, then there is a sofa on the left-hand side which happens to be at an angle, which is interesting.

    And then there’s a drawing of a, looks like a painting of [01:00:00] a tree on the wall, but the first thing I see is a messy desk. That’s the first thing I see when I walk in, and it’s messy because of all the cords. It’s a low desk. There’s not anything inviting for me to come up to this. In fact, I see the back of a computer first as opposed to somebody’s face.

    Just changing that front desk is a possibility to create some more interest. You don’t want to see all that clutter when you first walk in. So whatever you can do to change that desk would probably be a benefit.

    The other thing is I would love to see potentially even a screen or something in front of that break room thing, because you’re walking in and all of a sudden you [01:01:00] see like you’re walking into a kitchen, a break room feeling.

    I love the art above. The art’s attractive but if you could take the front desk and make it so that you didn’t see the cords in the wall and you had maybe a little bit of angle and then you maybe create some kind of screen behind it or some kind of something so you’re not seeing that messiness, then you immediately walk in and see something inviting, you’d see the person’s face right away and not messy, if you follow what I’m saying.

    Dr. Sharp: Absolutely.

    Carolyn: If you just did that, and then it looks like you have a table on the far left over there, is that functional or is that for the break room? What’s happening over there?

    Dr. Sharp: We use that table as a little workstation for parents who are dropping their kids off and need to stay for a few hours while the kid is in the appointment. So it’s just a little work desk.

    [01:02:00] Carolyn: So it’s very functional. I think there’s other pictures so I can see more of it. This first impression, that’s what I see and then all of your art could be rehang.

    It looks like the art, the two above the front desk are way high, really high. They don’t seem to have a lot to do with each other. They’re pretty all by themselves, but they’re almost like they’re too close together to not match more, and they’re too far apart to be a composite.

    What is that? It looks like a telescope.

    Dr. Sharp: For the folks who can’t see it, this is our logo. It’s a woodworking piece. So it’s a wood rendition of our logo that’s about 3 feet across and 3.5 feet up and down.

    Carolyn: Yeah, if there was a way to have [01:03:00] that wall and that logo right there. A logo typically is higher than the 6 feet but it looks too high because I’m seeing how close it is to your ceiling and even if your ceiling was 8 feet, that piece is a little too high.

    Also when your ceilings are low, you can get away with your pictures being lower; when your ceilings are higher, you can get away with your pictures being higher because of that feeling of how close they are to each other.

    Dr. Sharp: That makes sense.

    Carolyn: It may actually measure at 66 inches to the middle, but it just feels too high. Some things are not rules, they’re intuition-type things.

    That yellow piece of art says something; do awesome, be awesome. It’s drawing my attention, but it’s just drawing it [01:04:00] to, they just don’t go together. They’re both good-looking pieces, they just don’t go together.

    So if you could put some kind of screen to block that back then that screen and the desk became more solid. So you hid all those wires and hid all of those things. You didn’t see everything and maybe it turned at an angle. Maybe everything comes to an angle. I don’t know. I don’t see the floor plan and then move that picture somewhere else so that my eye just sees what I want to see. Start there. You want to go to the next picture because I can’t see all the …?

    Dr. Sharp: Yeah, of course.

    Carolyn: You’re recording this so you can, there we go. See those three pictures, those are perfect to pull them close together because they’re all basically the same size. Do you follow me?

    If you were to take all three of them and you were to, you have two sofas, you have a lamp and you have a little waiting area and then you have the [01:05:00] side and then the yellow piece of art has a similarity to that make it happen blue piece of art, those could potentially go together.

    I don’t see them side by side, but it looks like they’re close to the same size and they both have a similar frame. That could make a larger picture. If you took those three pieces and you pull them together, you lowered them down and you decided to focus them over one of those, maybe the sofa in the middle.

    I’m not sure if you could rearrange your sofas at all. Have you tried to turn? I don’t know if you have the room to change your sofas. I don’t think they’re horrible where they are and I get where everything, but if I just look at that wall and you took those three pieces of art, you lowered them and put them [01:06:00] 6 inches or so apart and just right over that sofa, that would make a big difference without moving anything.

    Dr. Sharp: I see. My concern with something like that, I would love to get your opinion, when you bring pictures closer together, then I worry about what happens to the rest of the wall. Does the rest of the wall look open; you know what I mean? That’s why I spread them out so much.

    Carolyn: Lots of people do that. You want to give a focus so it’s okay if the rest of the wall is open, just giving that focus piece right there. If you feel like you need anything, you’ve got a lamp in the corner so it gives some height, you could put something on the desk to give it some height on the other side, just to anchor it firm as necessary.

    I’m looking at two big water bottles. I don’t know if those have to be there. I know that they’re there.

    [01:07:00] Dr. Sharp: No, they’re not normally there.

    Carolyn: Oh, they’re not normally there. So that would be a good thing to put in the storage. If you do put a screen and you walk around the corner, you’re going to have to walk around the corner farther to see the front door. That’s a potential challenge and that’s a functional thing. What you could put there, if it’s not too big, so it’s just a little bit more of a …

    Dr. Sharp: Just something to break up that and hide that little kitchen area when people walk around.

    Carolyn: Yeah. The main thing is you want to hide the kitchen area and give more of a focused interest on that.

    Dr. Sharp: Okay.

    Carolyn: You have one more picture somewhere, don’t you?

    Dr. Sharp: Yeah, I have one more photo.

    Carolyn: This pretty much [01:08:00] shows. This is what I would do with that yellow picture; see where the blue picture is and you’ve got a lamp behind that thing, if you lowered that, however, far the right edge is away from the wall move the yellow picture that far away from the wall so that the two pictures and the lamp become a composite in that corner.

    Dr. Sharp: Yeah.

    Carolyn: It’d be that easy. And then you’re pulling that yellow picture away from your logo. And so they’re not conflicting with each other any longer, but the two pictures look like a grouping would be another word, composite or a grouping.

    Dr. Sharp: Yes, that’s great.

    Carolyn: And I can’t tell, is there a window there as you enter the hallway, what is that?

    Dr. Sharp: Yeah, to the left of the door.

    Carolyn: No. I’m sorry. As you [01:09:00] start to go down to the offices, what’s on the wall?

    Dr. Sharp: That’s another framed picture.

    Carolyn: Okay. I can’t tell exactly what it is from the picture.

    Dr. Sharp: Yeah. Gosh, how would I describe it? It’s one of those maps of our city where the background is this mossy green and then all the streets are in white. So it’s just a street map of our city.

    Carolyn: So it works. It’s fine. Especially if you ended up with an angled wall right there to block some of that. The other thing is you do have 2×4 light fixtures in your ceiling and it would take a lot of lamps to make it bright enough in there. If you’re going to have 2×4 light fixtures, it’d be nice if [01:10:00] they all were going the same direction because you see how they’re all in different directions.

    Dr. Sharp: I do see that.

    Carolyn: You can also get filter. You can get lenses or things that cover the lenses that make the light level a little bit lower and not such a wash of light. Do you own the building or are you renting?

    Dr. Sharp: No, we’re just leasing.

    Carolyn: You’re just leasing and stuff.

    Dr. Sharp: We could do that, though, they’re okay if we want to put some filters or covers on there.

    Carolyn: Put some filters or covers and add some more floor lamps and just see if you can, if they’re fluorescent, sometimes you can take out bulbs and just lower the light level. So you still have light, but it’s not that bright wash of light.

    You could keep the light above your break area because you want it brighter. That is a place you need [01:11:00] light is in your break area. So what do you think?

    Dr. Sharp: This is great.

    Carolyn: I hope you’re taking notes.

    Dr. Sharp: I am lucky we’re recording. I’m going to tell my office manager to go back and listen to the second half of this interview and she’ll get lots of ideas. No, this is great. I think the changes are very doable and totally makes sense to me.

    Let me ask you one more question. We have this tree decal thing. It’s not painted on there, this is just a big sticker, essentially. We put it there. We’ve been in this office space for 8 years now, maybe and this waiting room has gone through a lot of different iterations and arrangements.

    And so back in the beginning, we had a little sitting area with some toys. It was designating the kids’ area, [01:12:00] so to speak but now it’s just in a random place in our waiting area. I’m curious if you have any thoughts about this tree decal.

    For people who are listening, it’s one of those decals. You can get them online, but it’s like a 6-foot-tall branching leafy tree decal that you can put on your wall. It’s got cool, nice little colors. It looks almost cartoony. So I’m curious what you might do, do we take it down?

    Carolyn: If not offensive, would you do me a favor and go back to the one that I can see the chair in the corner where I told you to move that yellow picture over?

    Dr. Sharp: Yeah.

    Carolyn: You know what, if you move the yellow picture over, it’s going to be on top of your tree. So yeah, you need to take the tree down. You’ve had it there for a long time, it’s not going to be a sad thing to take it down.

    Dr. Sharp: I think we can say goodbye to the tree.

    Carolyn: Yeah, I think if [01:13:00] you took those two pictures and you lowered them and you’ve got that at an angle and I’m sure you put that at an angle. I’m sure you’ve played with how you can arrange the room several different times, but I like the angle. It doesn’t feel stuffy.

    Anytime you can do it, especially if you do your desk at an angle, do that at an angle and you can do your desk at an angle, it’d be good. You can find really cool looking front desks on Etsy for fairly inexpensive.

    Dr. Sharp: A piece of furniture on Etsy.

    Carolyn: Yeah, people make it and they ship it to you. It’s just a place for craftsmen to show their stuff because you don’t need a very big one. They don’t make real big ones, but they make some that are fun but I like [01:14:00] the white. I like the white and the lightness of the space.

    But if you could just get a vision. What I would do right now with a client is we’re sitting here talking and then I would go on to the website and Pinterest and start showing them things. We can maybe do that afterward to show you different kinds of ideas. So good things that are in a designer’s head, a picture speaks 1000 words.

    Dr. Sharp: Yeah, for sure. This is awesome. I appreciate you going through this experiment.

    Carolyn: Yeah, this has been fun. Mostly what I’m talking about is not, [01:15:00] you don’t have to be a degreed licensed interior designer to tell you what I’m telling. That’s where a designer knows that they start. They love that kind of, we call it accessorizing, we call it staging, whatever, it just happens. It’s the creative design thought of just moving things around.

    In fact, most people that I know that are designers; they move the furniture in their room every 6 months and they move the furniture in their house. It’s just that thing that happens to us.

    Dr. Sharp: Sure. Thank you for doing this. I’m going to stop the screen share and go back to our interview here. I would love to ask you two more questions as we start to wrap up and then we’ll say goodbye.

    One of the big questions when we get into anything related to design or layout is I don’t have that much money, [01:16:00] what is most important? So if you had to pick biggest bang for your buck choices in the design, primarily the accessorizing or staging or things like that, what would you say?

    Carolyn: I’m going to say this, it really depends on, like what we were doing in your office and stuff where we were just moving things around, the only money I spent, as I said, you need a new front desk. So that’s where you would put your money. I don’t even think I’d buy anything else.

    Usually, it’s that first thing you see when people walk in. It’s the wow shot, the money shot, the first thing they see. I [01:17:00] want to say, it doesn’t have to be expensive. It just has to be thought through and intentional.

    You can probably find a desk on Etsy for $1000 in comparison to these big built-in desks for $10,000, it’s not really that much money if you don’t get too big; the bigger you get, the more it cost. I don’t know what a back wall screen would cost. Something that would look more finished.

    I’ve got some different ideas, even pieces of acrylic that are attached on cables, the ceiling, and the floor and stuff. You don’t want to divide your screen; you don’t want that. You need something that’s more fixed, but you don’t want it to have legs to make it stand up. So it’s going to be a search process or you build a wall, something of that sort.

    You want the first thing [01:18:00] people see when they walk in to be the, it’s just like the first part of a website; your hero image and your first words and all of that, it’s got to draw them in and fill attention. So that’s where you want to put the most attention.

    Money just depends on how bad everything is or how good everything is. If your furniture is really shabby, and we have a free checklist for your listeners called the 5 Point Designer Checklist, it’s what we use as a guide similar to what I was doing with you to walk through the space.

    You basically checked off a lot of it. We talked about lighting, but we say, don’t try to do it yourself because you’ve lived in the space so much, you don’t see it anymore. It’s better to have it with some other person that you trust to give that impression of.

    [01:19:00] It’s shows you what you need to fix right away, and what’s your first impression? How dirty is it? How cluttered is it? Uncluttering and getting things clean is not expensive. That’s very important to know things about.

    I know some therapists work in their office and meet with people, your desk was extremely clean compared to some that we’ve seen. I think about the people that go into law offices where the lawyer has stuff everywhere making you to think, can this guy keep up with anything?

    It’s an interesting psychology that happens with us. And then we use a judgment that we have, that immediate perception, let me use perception over judgment, of our perception of what we’re seeing, does that help?

    Dr. Sharp: Absolutely. This is fantastic. I’ve really enjoyed the conversation. I feel like [01:20:00] it’s very complicated and there’s a lot to dig into, but this was great. We covered a lot.

    Carolyn: I’m going to say this, there are people that can help you do this; whether you hire us or you hire someone else, especially the staging and the decorator part. It’s just like I can’t be a therapist. I’m not going to be a therapist, that’s not my thing, I hire someone. If I need a therapist, I hire a therapist. So don’t try to do it yourself. If you could do it yourself, it already be done.

    Dr. Sharp: Exactly. I’m going to ask one last question just around that idea because I run into folks who will build a website or maybe decorate their office. It seems to come up more with the website, though. They’re like, [01:21:00] I did this myself and let’s just be honest, it does not look good or it could look a lot better, let’s say. So I’m curious, do you run into that with folks and how do you navigate that as the consultant or designer?

    Carolyn: When they come to us, they realize they can’t do it.

    Dr. Sharp: Okay. So they’re already admitting defeat, so to speak or they admit that they need some support there.

    Carolyn: Yeah, most of them. Occasionally, we’ll have them come to us because we’re real experts at office flow, practice flow and stuff. We’ll have them come to us and they don’t want the aesthetic piece at all. You look at it and go, I can make you flow better and it’s going to help increase your efficiency, but it’s not going to add …

    So the flow increases in efficiency and helps reduce overhead, I’ll call [01:22:00] it, where the aesthetics increases revenue and increases attraction. So we can work on flow all day long, but it’s not going to help that attraction, if you don’t want to get rid of your chairs that are from the 80s which, by the way, you can still buy chairs that look like they’re from the 80s. So it’s not how old the chairs are, it’s just the style.

    I do work with students and teach students as I was telling you earlier, and we say, get the highest style you can get with the least amount of money you can and put it in your budget to replace it in 5 years. So you can put residential furniture in a doctor’s office easily, it’s just going to wear out faster because it’s not intended to be in a commercial space like that.

    I hate it when [01:23:00] they buy these chairs, they’ll buy chairs, they’ll find them on some office liquidator and they’re already dated. It’s like okay, yeah, there’s structure. They’re good. I understand but the wood tone is from the 80s and the fabric is from the 80s, what are you doing here? So it’s sad.

    So don’t try to do it yourself. The whole purpose is to help you guys be better-educated consumers and to understand what you’re dealing with.

    Dr. Sharp: I think we accomplished that mission. I have a lot to think about. I’m going to go to my office manager with a big long list of things to work on.

    Carolyn: Not too much. We didn’t think too much.

    Dr. Sharp: That’s true. No, I really appreciate it. Thanks for being here, Carolyn. This is fun.

    Carolyn: Yeah, I had fun. I haven’t done this on a podcast before. I’m going to remember this. I can’t wait till it comes out. So that’ll be great. Thanks.

    Dr. Sharp: Nice. I’m super [01:24:00] grateful and I hope that folks found it helpful as well and hopefully, our paths will cross again soon.

    Carolyn: Oh, we’ll plan on it. Thank you, Jeremy. I appreciate it.

    Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode, always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.

    If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes, Spotify or wherever you listen to your podcast.

    If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting.

    [01:25:00] If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call, we will chat and figure out if a group could be a good fit for you. Thanks so much.

    The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

    Please note that no doctor-patient relationship is formed here and similarly, no supervisory or [01:26:00] consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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  • 472. Design as a Marketing Tool w/ Carolyn Boldt

    472. Design as a Marketing Tool w/ Carolyn Boldt

    Would you rather read the transcript? Click here.

    Yes, layout and design of your office is definitely a part of your marketing and branding! Today’s conversation with Carolyn Boldt from CrossFields Interior & Architecture was SUCH a blast. We definitely cover some of the basics of layout and decoration, but we also spend a lot of time doing a live consultation where Carolyn looks at photos of my current waiting room and personal office, then gives tips on how to improve the spaces. With such a visual component, I definitely recommend watching the YouTube video if you can! Even if you can’t, there’s plenty to take away from this discussion to help make your office as inviting as possible. Enjoy!

    Cool Things Mentioned

    Featured Resources

    I am honored to partner with two AMAZING companies to help improve your testing practice!

    PAR is a long time supporter of the Testing Psychologist podcast, and I will continue to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

    TherapyNotes is the leading EHR system for mental health practitioners. I’ve used TherapyNotes for over 10 years, and it just keeps getting better. Use this link and the promo code “testing” to get two free months and try it for yourself! www.therapynotes.com/testing

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    I’ve partnered with At Health to offer CE credits for podcast episodes! Visit this link to access current and past episodes available for CE credit. You can use code “TTP10” for a discount on ALL the course credits you purchase from At Health!

    About Carolyn Boldt

    Carolyn is personally passionate about holistic health and wellness, and an outspoken advocate that the environment of your space impacts your success.

    With over 40 years of experience in the commercial interior industry, she holds a BS in Interior Architectural Design from University of Texas at Austin, is NCIDQ Certified, a Registered Designer, a LEED AP, and Professional Member of IIDA/International Interior Design Association.

    In 2004, she and her husband, Scott, co-founded CrossFields as a design-build firm in Atlanta. In 2011 they changed their focus to expand the impact of holistic health by elevating the public’s image of alternative medicine through virtually creating outstanding healing environments nationwide.

    Carolyn loves to spend her time with her 8 wonderful grandchildren, involvement in church and community activities, traveling, and boating on the lake with her husband.

    Get in Touch

    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

    Ready to grow your testing services? Click below to schedule a complimentary 30-minute pre-consulting call!

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  • 471 Transcript

    [00:00:00] Dr. Sharp: Hello everyone and welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

    Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get 2 free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.

    This podcast is brought to you in part by PAR.

    Hey, guess what y’all, the BRIEF-A has been updated. The BRIEF2A is the latest update to the BRIEF2 family. Use the gold standard in executive functioning assessment to assess adult clients. You can preorder it now, visit parinc.com/products/brief2a.

    Hey folks, welcome back to the [00:01:00] podcast. I am excited to be here with you and so glad to be able to share my guest today, Dr. Janice Lepore. She is a Maryland licensed psychologist who has provided assessment, therapy, and consultation services in schools, hospitals, clinics, and her own private practice for the past 20 years.

    Over the past 10 years, she has also been engaged in local and state-level policy and advocacy addressing issues related to mental and behavioral health, education, disability access and inclusion, and health equity and access. In 2023, Janice was selected as an APA/AAAS Congressional Fellow and placed her practice on sabbatical to spend a year embedded with the Health Policy team at the US Senate Committee on Finance.

    If that sounds super interesting, then you’re in the right place. That is what we were talking about here today during the podcast. Janice has made the leap from being a psychologist to a legislator and advocate. And that’s our conversation today.

    So we talk about [00:02:00] Janice’s journey, how her personal experience got her into this area and the work that she did with legislation and activism prior to the fellowship, we talk about the fellowship itself, how you apply, the interview process, we talk about the daily life of a Congressional fellow, we talk about surprises from her time in Congress, and we also discuss ways for all of us to get involved if we can’t work in Washington, DC for a year as some can. So we talk about local and even some national ways to get involved even if it falls a little short of moving to DC.

    This is a fascinating conversation. I’ve known Janice for years and have always respected her voice and the way that she shows up primarily in The Testing Psychologist community on Facebook. She is always a very reasonable, rational voice in the group and research-driven, which I think we [00:03:00] can all respect. So I hope you enjoy my conversation here with Dr. Janice Lepore.

    Hey Janice, welcome to the podcast.

    Dr. Janice: Hey, thanks for having me.

    Dr. Sharp: I am glad to have you. We are talking about something today that is completely brand new to the podcast. We’re talking about, I don’t know what I would call it, activism or advocacy or maybe just careers outside of psychology but I’ll leave that to you to put the right term on it, but in either way, I’m thrilled to have you here and very curious to hear about your experience outside the traditional psychologist path. So thanks for being here.

    Dr. Janice: Absolutely. I’m happy to be here. I think you could use any one of those [00:04:00] terms and probably two more. Everyone’s path is a little different than they define it themselves, but I’m happy to talk about my path and what I’ve been doing the last year or so.

    Dr. Sharp: Okay. That sounds great. We’re going to get into so many details around this and what the experience was like, but I’ll ask you that question that I ask everyone right off the bat, which is, why do this? Basically, why is this important or meaningful to you?

    Dr. Janice: Sure. I brought to my career some personal experience, an advocacy mindset or an advocacy approach just tending to think about how the systems are working or not working, and who is being impacted, who is in the driving seat, those kinds of questions have always been a little bit of who I am as a professional.

    And so I think for me, especially in the work that I did clinically working with children and [00:05:00] families, that led me to pay attention to some of the systems issues that can come up when we’re trying to coordinate different kinds of care and different kinds of services, interventions, and support.

    For me, that also led to asking questions about the policies that created some of those situations and asking whether we could do something to change those policies, to make things better, to ease the way, and eventually that led to two of, I jokingly say, side gigs, some volunteer positions doing some advocacy, doing some policy work and then eventually being invited to write legislation for my state to try and address some questions and some issues around early childhood screening, identification and intervention.

    Over time as I was doing my clinical work, I was also taking on these policy and advocacy roles, I became, and we’ll talk a little more about it, but more and more interested in doing more policy work [00:06:00] and making a potential career shift. And so as I was exploring how that might look, I decided to apply to the Congressional Fellowship that is offered by APA, the American Psychological Association, in partnership with AAAS, the American Association for the Advancement of Science.

    I had known about the fellowship for a long time but had kept putting it off and not applied. Finally, I decided this was the year to apply and I was fortunate to be offered a position and then to go off to DC and do a yearlong placement with the United States Senate.

    For me, it was an exploration of policy as a profession. It was something that I liked to do all the time. It is a full-time opportunity that’d be interesting to me. And so my why is a little bit of a combination of wanting to do good work, continuing to want to serve the mission like I have as a psychologist, and exploring a new career path.

    [00:07:00] Dr. Sharp: Sure. I know that a lot of factors came together to make this possible for you. We’ll talk about some of those things but right out of the gate, this is super interesting and compelling. I know it’s a path that not many of us get to take and you’ve had a really cool opportunity here.

    Maybe we go back and start in some of the background. You said, I took on two side gigs and did a little advocacy, and then all of a sudden we were writing a bill. I think people might be interested in those beginning steps and what that means when you say side gigs and advocacy. How did that even turn into writing legislation before you even took this fellowship?

    Dr. Janice: It happened the way it sounds. I think that’s an important story to tell because that’s one thing that, to me, is really important [00:08:00] when I talk about my path into policy and through policy is that it often feels to people like it’s got to be this big commitment. You got to move to DC or you got to go talk to your senator, and they’re hard to get ahold of.

    My path into real policy work started because I was a parent of a child who was identified with dyslexia. She was identified later than we would all agree is ideal, at the end of 3rd grade, even though she lived in my house. And that’s what I do for a living is identify kids who have learning differences and support them.

    And so I was just in a parent group with other parents of kids with dyslexia, and talking about how many kids got late-identified and how many kids get identified much later than 3rd grade and what we know about intervention.

    They were asking me; don’t we know that early intervention is the best? Yes, we do, we know early intervention [00:09:00] changes lives and changes brains. They said, we should be able to identify kids earlier than that. I said, we should. They said, we think we should do early screening and I said we should. They said, we’re going to write a bill, you want to help?

    It was that simple. Was I in those spaces because I had an advocacy mindset and was I willing to talk about those things because as a psychologist, we talk about those things all the time? Yes, but the fact that it came together in that moment was happenstance and a little bit of luck.

    Honestly, that’s how I think a lot of policy work. So I said yes, and then started working with a grassroots organization. It’s Decoding Dyslexia. Different parents and different professionals may have had some contact with it.

    This has been my experience throughout as I’ve had more experience with policy. Policy starts with a good idea and committed people. And then you start talking about what should be in the [00:10:00] bill, what do we need to be thinking about.

    My contribution to that piece in this particular place was saying, we need to have solid science in the bill. We need to be talking about what has to happen with the assessment, that it should be reliable and valid assessment. We need to start talking about the components and the skills that we should be assessing. And you go back and forth.

    We didn’t write a whole bill reflecting the totality of the psychological knowledge about assessment because that would be pages and overly burdensome so then you bring it back and we say, okay, what else do we need? We need to make sure there’s intervention as well.

    Okay, we need to be partnering with our school psychologist colleagues. They’re going to know how this looks in the school. We brought that person in from our state school psychological association. So that collaborative effort and that back and forth is how bill development goes. And that was my experience with my first bill.

    And then we did the next part, which is, okay, you need a sponsor. How do you get it into the legislature? [00:11:00] How does the bill even get introduced? The Schoolhouse Rock version is not wrong; it’s just lacking in some detail.

    Dr. Sharp: Oh yeah. Let’s run through that real quick just for folks. I’m very curious about that too. How do you go from a bunch of parents sitting together in a room and writing something cool or not, and then getting people to pay attention to it?

    Dr. Janice: Then you start meeting with your representatives or you have relationships. And so Decoding Dyslexia was an active group already in Maryland. They had some relationships with legislators.

    You go and you tell people, this is what we think should be happening. Here’s our rough draft of what we think we should have in a screening bill. Are you interested in supporting it? Would you be willing to sponsor it? Are you interested in asking other people whether they’d want to sponsor it?

    Ideally, in our case, eventually, you get a yes, and then you have sponsorship in the legislature and they know how to introduce it and start working with the staff. Who else [00:12:00] do we need to sponsor the bill?

    If you’ve got somebody on the Senate side of your general legislature, then you also need somebody on the House side. It has to go through both houses in order to pass and become a law, so it has to be introduced usually on both sides.

    So if you’ve a sponsor on one side, you got to get a sponsor on the other side but usually, the legislator that you’re working with will have somebody that they also work with frequently or feel would be interested in this bill and the staff and the representative help you figure out like who the logistics are.

    It’s a whole process from there, once it’s introduced, it gets assigned to a committee, the committee looks at it, there’s hearings, there’s testimony, there’s witnesses for, there’s witnesses against. It has to get passed out of committee, then it has to get passed off the floor of the particular chamber, the House for the Senate, then it has to get up in the state level to the governor, the governor has to decide to sign it or veto it. So there’s a lot of steps in the process and it often takes quite some time.

    Dr. Sharp: How long did it take [00:13:00] from start to finish with this particular bill?

    Dr. Janice: From start to finish, I’m not sure I could even time it because I did not, unfortunately, write down the date that I was invited to start working on it. We needed to put together an advocacy campaign for two consecutive sessions of the general assembly.

    In Maryland, we have a general assembly that meets for about 3 months between January and April. The way that the Maryland General Assembly works, everything that gets passed in the state gets passed in that window. You have to introduce it, after the general assembly opens, it has to get passed by the final day of general assembly session or it dies and you have to rebring it up the next year.

    That’s not how every state legislature works and that kind of timing isn’t what every state legislature follows. Some legislatures meet once every 2 years. Some meet for a longer period of time. Some have what are called carry-over [00:14:00] bill. So if it doesn’t pass the session, you can try it again next session.

    For us, we were not successful. We got very close to passage in the first year. We successfully got it passed out of the House side, but we’re not able to get it successfully passed out of the Senate side finally. So we didn’t get it passed in the first year and we had to come back, regain plan and carry it through the second year.

    We were able to get it passed in two sessions, which is lightning fast. Usually, it does take three or more to get something through the General Assembly.

    Dr. Sharp: Got you. Where did you go from there? I’m just thinking about the timeline and your experience here. So you had the experience with the state legislature and then what was the gap before the fellowship became a possibility?

    Dr. Janice: I was running a private practice at the [00:15:00] time, raising three kids and continuing to do those things and to be a clinician, to work with local schools and organizations, to work with my kids’ schools and talk about different things that we saw systemically that we could maybe change.

    We also were continuing to do some work. One of the important things to know about passing policy is that once it’s signed into law, you start the real work because once it’s signed into law, then it has to get implemented by whatever agency is in charge of it, in our case, the State Department of Education, they have to write regulations.

    So the letter of the law is one thing, but then the regulations around how it gets implemented is often written by the agency on the back end and those regulations can change how the law actually works in the world, [00:16:00] either for the better or for the worse.

    So as an example Ready to Read, when we wrote it, we initially wanted to have screening for everyone in kindergarten through 3rd grade, and through negotiations on the bill, it wound up being kindergarten and 1st, we 2nd and 3rd grade. There were other negotiations, but that was one of them.

    On the back end when it finally got out to MSDE and they started writing the regulations and they did the implementation, we had a change by that point in our state superintendent and he looked at the Ready to Read requirements, I haven’t said this before but Ready to Read was the name of the bill, the Ready to Read in Maryland.

    So our state superintendent looked at it and said, why aren’t we screening kids in 2nd grade and 3rd grade, too? We members of Decoding Dyslexia and other advocates in the reading community were continuing to watch the implementation and make sure that it had carried out correctly and said, yes, we [00:17:00] do. We think that’s a good idea. So he wrote that into regulation.

    And so now the impact of Ready to Read is expanded because the regulatory change was put in place and they didn’t go back and rewrite the law, which they don’t have to, especially if they’re expanding it. They can do some things in regulation.

    So that was part of what I was doing and then I got approached for different opportunities. The National Center on Learning Disabilities asked if I would be willing to work for their policy advisory committee. I had approached my professional organization, the Maryland State Psychological Association, to be supporter of the Ready to Read Act and they in turn invited me to come work with them on some of their legislative priorities and some things that they were trying to do.

    So I was doing some of that work. There in Maryland, we were trying to do, we still are in the process of statewide education reform. There were some nonprofit organizations that I was working with as an advocate and doing a lot of that work, [00:18:00] like I said, on the side while I was running the practice and raising my kids and navigating COVID as we all did.

    So that’s what took up the time between 2019 when Ready to Read passed and then 2023, which is when I decided to apply for the fellowship.

    Dr. Sharp: I see. It sounds like just getting into that world opened up a lot of doors. I would imagine that once you go down that path and start to interact with and make relationships with certain groups or individuals, it’s a lot easier to continue down that path and people start to know your name. It sounds like you got a bit of a reputation as advocate or person who can do this work.

    Dr. Janice: Yeah. I think the other thing that’s important to know is that policy like psychology is very much about relationships. We hear that [00:19:00] played out sometimes as it’s got to be who you know. I think that’s true in a lot of spaces.

    What I mean when I say policies about relationships is getting to know the people who are working on the same problems that I consider to be important, getting to hear their perspectives, why they’re working on those problems, and what they think some of the solutions are, building those relationships is what is engaging and interesting to me about policy, what certainly has drawn me further into it especially when I found people with whom I disagree.

    What I have found and what’s been most meaningful to me about policy is working with policy people working on policy is the thing that probably has made me feel most optimistic and positive about politics in our country and our government and how it works because I’ve gotten to know [00:20:00] not the caricatures of people but the actual humans and why they’re doing this and what they’re working on.

    My experience has been that people are really committed to the mission and want to do good work and produce good results. There’s a lot of people with different opinions who are still willing to work on those same goals.

    Dr. Sharp: That’s really interesting to hear. That’s very encouraging because I think we do get, without getting in the weeds with political stuff because that’s a potential nightmare, but we do see certain characters, like you said, in the news more frequently than others.

    I’m so excited to dig into the details of this Congressional fellowship and what that was like as you were interacting with the “normal” everyday folks, the other folks who are not making headlines every single day and what that experience was like, but it sounds like it was positive and that’s honestly a little [00:21:00] surprising to hear you say that that made you feel a little more optimistic about things. That’ll be cool to talk about.

    Let’s dig into the fellowship experience, walk me through the bit, where did you hear about it? Did you get invited to apply for it? Did you do it on your own? How did this come about?

    Dr. Janice: I first became aware of the fellowship very early on, I was a new graduate, so it was about 20 years ago, which hurts my heart to say but that’s true. I was on an APA conference. It was here in DC. There was a table and they said we have these positions where you come full-time and you spend a year working on policy.

    And as I said, my personality and character, I came in with an advocacy mindset. There was a part of me that was like, that sounds really cool. I had just gotten this degree. I planned on a clinical career like a lot of us do. I had started a clinical career and I also [00:22:00] had young family.

    Disappearing to DC for a year was not in the cards, but it hung around in the back of my head, and I talked about it every now and then. If any of my friends are listening, they’re probably laughing because it was probably more frequently, every now and then.

    And then as I started to move from an advocacy perspective to working on policy, and then I got the bill, we worked, got the bill passed, and I was working in other volunteer policy positions more and more, I thought this is what I think I want to do. I want to spend more time doing that.

    And as we all know, I’m running a practice. I had employees for a while. It was a group practice. It was very busy. It was hard to find time to do the policy work. I couldn’t conceive of how do you disappear to DC. I’ve got teenagers now, it’s still not ideal but I also had this strong [00:23:00] sense that that was the next thing.

    I loved the clinical work I was doing. I loved serving our patients, but there was this really strong sense that this was the next thing that I was supposed to do. It took me probably a year or two of going back and forth and figure out, I don’t know if I could do that and here’s all the reasons why I can’t do that.

    I do have to give all credit to my partner and my husband, he finally said, we’ll figure it out. My employees went off and one started her own practice, another went back to work in the schools. They are very successful. I’m super proud of them, but all of a sudden I was back in solo practice and so I didn’t have to think about, I can’t abandon my employees anymore.

    The kids got a little bit older and they’re a little bit more self-sufficient and I still was, I can’t be in DC 5 days a week. My husband said, yeah, you can, we’ll [00:24:00] figure it out. This is important. What he finally said was, you’ve been talking about this for 20 years, would you please do it?

    The application is on APA’s website. I went and I wrote up the application and didn’t know how it was going to go. It’s a very competitive process. Lots of really good people apply each year. I did the interview and then was offered the position.

    Just to clarify, APA right now sponsors 3 Congressional fellowship positions and 1 in the executive branch, which is like the Agencies and Administration, Department of Health and Human Services, and Department of Education.

    Dr. Sharp: Okay. That’s wild. So you applied and it happened.

    Dr. Janice: I applied, I interviewed, I was offered it in March 2023, somewhere around there. And then the actual fellowship starts in September. And so between March [00:25:00] 2023 and September 2023, I figured out how to put my practice on sabbatical and get my kids arranged and arrange my life.

    And then September 1, 2023, I took a train down to DC to start orientation and see where things went from there. I didn’t know how it was going to play out.

    Dr. Sharp: Of course not. It seems like a huge leap. One of the things that jumps out at me right away is major imposter syndrome. So thinking of myself, going into an environment like that, which feels pretty scary and new and like a fish out of water situation, I’m interested to hear how you worked through that.

    I assume you felt some of that, if not, I’d love to hear why you didn’t and what kind of superhuman you must be. Let’s talk through that if you’re willing.

    Dr. Janice: No, I live with the imposter syndrome and I think most of us [00:26:00] do. I have made my peace with it a little bit.

    I will never forget about 10 years ago, a good friend and colleague of mine who is globally known and has written bestselling books mentioned that he felt like an imposter when she was invited to speak on the topic of her expertise. That was a moment for me where I thought, okay, then imposter syndrome never goes away and I’m just going to have to live with it.

    Definitely, I’ve felt that and I took that with me to DC. Especially when I was stepping into the orientation and I didn’t know how the placement process worked, I didn’t have the opportunity to be quite as intimidated because at first it was just doing a two-week orientation on policy with scientists who are interested in policy.

    So the AAAS Fellowship, who APA partners with, is doctoral level [00:27:00] scientists of all disciplines who are interested in policy. It was just a group of people who love science and policy. It’s a major geek fest. It was great.

    So we were learning about different things and then I was meeting different people who had a PhD in entomology and somebody who had done a dissertation on mushrooms. It was a really cool time just getting to know these people and why they were in policy and which ones they were interested.

    They’re working on climate policy; they’re working on all sorts of different stuff. That was a great 2 weeks. The imposter syndrome hit when we had to go around and do interviews.

    Dr. Sharp: Okay. Tell me about that process.

    Dr. Janice: Yeah. That process is a lot like the Internship Match. There were several moments in the process where I thought, I can’t believe I did this to myself again.

    You get a listing, as fellows, we get list things of the offices who are interested in having [00:28:00] a fellow and it’s a full-time fellow that’s funded. So that’s a great resource. A lot of the offices are deeply interested in having somebody who has expertise in science and who can speak to science and communicate how science translates to policy. So there’s a lot of interest in the fellows.

    We get the book; it describes the different offices that are interested. I thought through who I might want to work with. I had a little bit of sense who’s on what committee, who does what, I was coming in with that sort of information.

    So you figure out who you might want to interview with. You see who’s offering a position and then it’s just emails back and forth, I’d like to interview for a position or they invite you.

    I was invited, where I wound up was the Senate Finance Committee. When I was invited for an interview to Senate Finance, I was confused because I didn’t know anything about the Senate Finance Committee. I didn’t know why [00:29:00] they would need a health fellow, which was the area I was focusing in.

    So I had to flip back to the job description and realize that Senate Finance is where all law is made around Medicare and Medicaid. Also, ATA plans and exchange plans all reside in the Senate Finance Committee. So that was my first learning. And then I accepted the opportunity to interview.

    I don’t have a background in Medicare and Medicaid policy. I didn’t know very much about it. Most of my work previously have been in education but I was looking at the fellowship, as I said, as opportunity to learn about policy work. My approach to that was I’m going to take the hardest thing I get offered, and Senate Finance and Medicare and Medicaid policy definitely sounded like the hardest thing I could do.

    So I interviewed. The whole interview process definitely was an exercise in imposter syndrome. I interviewed in 19 different offices over a course of 3 days. [00:30:00] It was exhausting. I got asked questions I did not know the answer to. It’s been a very long time as a person who’s been in micro for 20 years that I did not have answers to questions.

    Dr. Sharp: Sure.

    Dr. Janice: So you had to get comfortable with that.

    Dr. Sharp: Yeah. I want to focus on that for a second. I was talking with a colleague of mine who’s doing the Psychopharmacology program; the Master’s in Psychopharmacology. It was a similar thing; it takes a lot.

    I think it’s a vulnerable process to go from this point in your career where you’re presumably quite successful, knowledgeable and secure to put yourself back into a novel situation again where you don’t know the answers to questions and have to be a learner again.

    Dr. Janice: Yeah, it was very challenging. It was an amazingly good experience though. It was really great to be able to do that. I had to get comfortable with being off balance [00:31:00] and not knowing exactly how things would pan out.

    Dr. Sharp: Yeah. Easier said than done. Yes.

    Dr. Janice: Once you do the interviews, there’s a specific day where they can offer you a position. And like the Internship Match, sometimes that works out well and sometimes it doesn’t. I did not get offered a position the first day that offers were made. The position I wound up in eventually was initially offered to another fellow.

    That was a challenging experience too. Several other fellows were in that position. One of the things we worked through is this is a very competitive process where we would all do good work in any one of these positions, they can only have one fellow. Sometimes that happens.

    But the second day, the next day, I was offered my top three positions. Senate Finance was declined and then I was able to look at that one and I had two other really [00:32:00] good positions. So I had a different day, the second day, trying to figure out which kind of experience I wanted to have.

    Dr. Sharp: Okay. What a turn of events. Oh my gosh.

    Dr. Janice: It really was. When I say kind of experience, just to explain a little bit, you can work in a personal office or in a committee office, then the two types of work are very different. A personal office is in the office of a representative or a senator and in that role, you’re very much representing the interests of their constituents, state of Nevada; the specific representative, Maryland 3, whoever those constituents are, that’s what you’re there to do. You’re working on the issues that are important to that member and to their constituents.

    In a committee office, you’re working on topics under the jurisdiction of that committee. So the laws that will come through that committee. So finance, as I said, is [00:33:00] where Medicare and Medicaid law comes through.

    We work with the entire committee staff, which means us, but also the personal staff of each member of the finance committee, and look at developing the policy that will come out of the Senate Finance Committee as a whole. So the work is different in scope.

    Dr. Sharp: I got you. I wanted to go back to some basic details of this. I assume this is unpaid, but maybe it is paid. I’m sure people are wondering about this.

    Dr. Janice: I wasn’t quite that brave. No, it is funded. APA posts the stipends for it each year. And so we had a base stipend of $90,000.

    Dr. Sharp: That’s not terrible.

    Dr. Janice: No, it’s not terrible. They provide some, right now, additional [00:34:00] funding for things like professional development. So if you want to attend a conference or things like that and also reimbursement for health insurance is a part of it. So it’s not free. You’re not going to become rich working in government, but that puts you right there with everybody else.

    Dr. Sharp: Okay. That’s honestly a lot better. I was thinking in my mind; this was either unpaid or like a postdoc situation where we’re in the $50,000 to $60,000 range. So that’s a lot better than I was expecting. I’m sure not the same as a private practice, but better than nothing.

    I am curious about the maybe personal logistics. Did you move to DC for a year or were you commuting every day? I know you live in Maryland, so maybe that was a little easier than it would be for some folks, but how did that work out?

    Dr. Janice: We stayed in Maryland. As [00:35:00] I said, we have three kids, they’re all in school and that’s, as you know, not something you try to disrupt. I live about 5 miles away from the train station. So I commuted into DC.

    My office has a policy where they’re in office Tuesday, Wednesday, Thursday, and then teleworking on Monday, Friday but each office is different. So each senator, each committee, representative runs their office the way they want. Some are there 5 days a week, some have a flexible telework schedule, and then there’s differences between what’s called in-session and recess.

    In-session is what you see under the TV when they’re debating bills, or they’re potentially passing work solution, when they’re working together. During periods of recess, then there’s not going to be what’s called floor activity. There won’t be bills or debates or things going on, and most often the members go back to their areas that they’re representing to hold town halls and do other kinds of things.

    For [00:36:00] me, it was commuting about 3 days a week, less in recess and good flexibility but that was definitely a part of my process of finding a placement. When I was doing those interviews, some of the questions I was asking were, what are your flexibility?

    Even with that, they were long days. I got on the train usually around eight o’clock, I got home usually around seven o’clock. There’s after hours staff and hearings and sometimes things went late. So this definitely wouldn’t have been possible for me without the support of my family who really wanted to see this happen.

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    Let’s get back to the podcast.

    Okay, that sounds good. It sounds like you were able to do the commute and that worked for your family. It sounds like it was busy certainly, but you’re able to make it work. What about the other fellows or folks who are maybe thinking about doing this, what did it look like for folks who didn’t live so close?

    Dr. Janice: As I said, we had 4 fellows total who are APA fellows. One moved from Maryland to DC and then another fellow moved from Florida to DC on a temporary [00:39:00] basis. Those two that I spoke about, we were also in Congress, so all three of us were in Congress together.

    The 4th fellow, who was an executive branch fellow, who worked with SAMHSA, a lot of her work could be done by telework so she wasn’t sure at the beginning of the fellowship if she was going to move to DC permanently. She lived in California. She wound up over the course of the year not having to do that, being able to come in when she needed to come in but spending a lot of her work doing her work remotely.

    I know that that’s true for the other broader AAAS cohort. There’s about 200 AAAS Fellows every year. Many of them do move to DC because it works for them and their families but there is some opportunity to do remote work or balance out a hybrid schedule.

    Dr. Sharp: I see. This is a dumb question, but I feel like I’m asking more of those this episode than others

    [00:40:00] so I just go with it. I feel like we see in the media, TV, movies, and all that kind of stuff, the hustle and bustle of DC, legislation, government, and all those things. Part of that, I feel like is always doing things after hours, parties, relationship building, and all that kind of stuff. Is that legitimate and did that touch this fellowship or not?

    Dr. Janice: Yeah, there is always work going on. There is always more work that you could do. There is always another thing that you could attend, another briefing that you could hear. People come into DC and talk about their experiences.

    Of course, we’re also covering the country. Our committee chair, Senate Finance Committee, is chaired by Senator Wyden. Senator Wyden’s from Oregon. [00:41:00] Oregon’s on a different time schedule than DC, and we want to know what’s going on in Oregon.

    The pace of work that we see from the outside is not unrealistic. That is how it works, but part of the learning this year too, was learning how to pace myself and decide when I need to set this down and move on or go home or when I needed to say, I’m going to stay late so I can go through this extra thing. That is definitely a part of the process.

    Dr. Sharp: Got you. What about the rest of the day-to-day? I’m fascinated by what this, when you show up to work in the morning, what do you do? What is a typical day in a position like this?

    Dr. Janice: I’m off fellowship now just to be clear. I finished August 31st [00:42:00] but the day-to-day, I don’t think it differs so much from psychology except that in policy, my schedule was even less critical.

    Dr. Sharp: It sounds like a nightmare.

    Dr. Janice: You walk in and you have your meetings and you have your plan for the day and whatever it is you’re working on. It could be a topic, it could be a piece of legislation, it could be hearing. Many of the committees hold hearings on different topics that they’re planning to build legislation on. That’s a whole research and involves process that goes on for months before you actually see those hearings emerge on TV.

    So you’re doing all of that and then something happens in the news or something changes in policy landscape or somebody makes some decision and something gets attacked, and now that’s what you’re working on. You have to set everything else aside and plans that come back.

    What do I do first thing? I check my [00:43:00] email. I check my schedule. I check the messages to see what might have changed and then make the plan from there. Okay, here are the pockets I have in here and these are the things I need to do.

    The committee staff is made up of our health chief who leads the team and then the default four parts of Medicare have a different senior advisor who’s in charge of that area. So they have Medicare Part A which is hospitals, Part B which is outpatient physician care, Part C which is the Medicare Advantage program in Part C and then that person also does affordable care as an exchange in coverage, and then there’s Part D which is the prescription and drug benefit.

    So there’s 4 senior advisors there and then Medicaid [00:44:00] has its own senior advisor. So there were 5 of them, our legislative analyst who keeps everything going and organized, and then about 4 interns or policy fellows, depending on where we were in the year in the cycle. So it was 8 to 9 people altogether.

    Dr. Sharp: Got you. How much of your day was spent on one-on-one independent work versus group meetings or activities? How did that balance out?

    Dr. Janice: I would say that the workflow throughout the experience was collaborative. You never have one person writing something or leading something or out there solo. They’re working with other members of our team. They’re working with other members of the Congressional staff, representative senators who are on the Finance Committee and working across parties, which I think is an important part.

    Everything that came out of the [00:45:00] Senate Finance Committee while I was working there and to my understanding, the history of the Senate Finance Committee is that it works on a very bipartisan basis. Everything that’s out there as a proposal or that gets put out as a bill for a vote has agreement from Republican offices and Democratic offices.

    Not all of them but at least agreement from some subsection. That’s a really high priority of the leadership of the committee and so it’s a commitment of the staff. So anything that you see in public is always a collaborative effort and something that we’ve worked on internally with the staff, but also externally with agencies and stakeholders and researchers and input from different outside people.

    I think that’s one of the important things for people to know too, that’s an opportunity to have input. You don’t have to go and move to DC, you can be available as a subject matter expert or somebody who’s willing to talk to the legislators about your experience and perspective and that can [00:46:00] inform the development of policy.

    Dr. Sharp: I definitely want to talk about how some of us might be able to get involved in this kind of work, maybe without moving to DC, I don’t know how doable that is but before we maybe totally jump to that topic, I’d love to just do a big picture retrospective; what do you feel like you took away from this experience? What was most surprising? What did you learn? What are you carrying with you? That kind of thing.

    Dr. Janice: I did not know before I did this how many opportunities there are to contribute, as somebody who is interested in science and interested in serving people, how many opportunities there are to do that in policy and in our government. There [00:47:00] are fellows and former fellows and other scientists in every single federal agency providing insight, advice, guidance and working very hard.

    I was in Congress, but there are people in Department of Education who are certainly helping human services, tons of them, Department of Defense, Department of State and there are former psychology fellows in all of those agencies that I just mentioned contributing to the work and trying to do good policy. That’s one thing.

    The other thing I learned that I didn’t know before was how incredibly bipartisan the work that is going on in DC is. I think that’s really important to know. It’s odd now to see the headlines or to see things talked about in the media as being always divisive, nobody can talk to each other and nobody can get together because I just spent a year in the most partisan place in the [00:48:00] country and if that were true, you’d expect nobody to talk to each other, but every people do.

    We work together ideally and everywhere all the time and is it a happy joy little place, no, it’s people working together on difficult things. And not everybody’s going to agree but very often and all of my year, I continually saw how different people with different perspectives on how to solve problems are coming together and working on how to make the best policy they can, and that’s the commitment is how do we make the best policy we can to solve some of the problems that we see.

    So the bipartisanship of DC was a learning and the opportunities for people interested in science and interested in serving others, it was a learning.

    Dr. Sharp: That’s inspiring. It’s really good to hear that. It’s easy to get caught up in the headlines and that doesn’t always make it sound like there’s a lot of collaboration [00:49:00] and working together happening.

    Janice: Yeah.

    Dr. Sharp: Thanks for sharing that. Did you get a front-row seat to APA’s work? I know a lot of people talk about how much APA is or is not advocating for us, particularly with rates with Medicare and CMS and that kind of thing. Is there anything you can say about that? If not, that’s okay.

    Dr. Janice: Yeah. The Senate and the House also have very strong ethics committees and roles. And so because I was funded by APA, I was not able to participate in anything that APA was lobbying on because that would be a conflict of interest and inappropriate.

    That said, I know the APA advocacy people, I knew them a little bit from some of my other work before I took on the fellowship and then I always knew when they were on the Hill, when they were doing a briefing. [00:50:00] Really committed team, want to do good work and solve problems.

    One thing that’s important for people to know in here and this is in general about policy is that the people who are working on the policy are very good at policy, but they haven’t had the experience you’ve had as a provider. Most of them are not like me, who decides, let me set aside this career and go do a second career.

    They haven’t been healthcare providers, and so they don’t necessarily know exactly what it looks like on the ground or what the challenges or experiences are that we’re having.

    If we want good policy to be written for our providers, we have to be in the game and be talking to the people who are working on the policy. There has to be communication. It’s not realistic to expect them to know what we need without [00:51:00] communicating.

    I know some people will say, I wrote an email. Yes, it needs to be persistent and it needs to be group communication and it probably needs to be multiple communications over time. Just like our work with our patients, it takes time to affect change so too in policy.

    Dr. Sharp: Of course. That’s maybe a nice segue to how many of us can get involved with this kind of activity from wherever we’re at. Do you have thoughts on?

    Dr. Janice: I definitely did this. This is a passion of mine because I do feel like the more diversity of participation we have, the better policy we get. And like I said before, I think the perception and I understand why it’s this way is that you got to go to DC to make any difference, but I made a difference just by being in a group with other parents [00:52:00], and saying, hey, I know something about this and I’d be willing to contribute my time.

    All participation at all levels is really valuable and it’s accessible and it can build on its own. So it could be something as, I don’t want to say simple or small because it’s not simple or small, but something as local as knowing who represents you in the various offices.

    For some of us, our board members are elected, then you have a representative. Certainly, in Maryland, we have representatives by district and then we have State Senate Representatives, just getting to know who are your representatives in your state legislature and what are they working on.

    You don’t even have to talk to them if you’re tired and you don’t want to, you can go to their website, they usually have a newsletter and sign up there where they have a town hall and you can [00:53:00] go. You can draft an email about something that’s important to you and send it along.

    All of those little initiatives that may feel like not very much are actually contributing. People do read all of those. I know, part of my job as a fellow was to read the comment letters and to put it all together. So all of those pieces of input even at the local level, at the state level are valuable.

    Dr. Sharp: That’s really good to hear. I think people get, myself included, I’m not just going to speak in generalities, I get overwhelmed with the options and it’s like a double-edged sword. I don’t know what all the options are, but the ones I do know of also seem murky and overwhelming. It’s hard to know what’s a good first step if we want to engage in some kind of activism or make a difference, so to speak, or anything in that realm.

    [00:54:00] Dr. Janice: I think the best first step, honestly, is find out who represents you and see what they wrote about in their last newsletter.

    Dr. Sharp: Yeah, that’s a great concrete first step. I love that.

    Dr. Janice: The other piece that I think particularly for our colleagues is get in touch with your state professional association. They probably have a legislative or advocacy arm that’s working with your legislature. So at very least they know what’s going on. They also have communication up to APA.

    If you’re not wanting to work at the national level, or I know some people are frustrated with APA but what about your state professional association? Are you communicating with them? Are you finding them to work? If that’s not working for you, there’s lots of other organizations that have government relations and policy arms, and you can just watch what they’re doing and be informed. That’s a great first step.

    [00:55:00] So NAMI and Mental Health America we all know these different nonprofit organizations that work on topics of interest to us. What are they doing in the policy space? Just so you know is a great way to start.

    Dr. Sharp: That’s fantastic. This has been a great conversation. I know that we could as always go into the weeds and so many different things, and I have a lot of simple questions about the whole experience that I’m not going to bore our audience with.

    This is fascinating. I love that you have made this pivot in your career. I’m curious where it goes from here. I know you’re considering a more permanent career change, has it been meaningful enough to pull you down this path a little more formally?

    Dr. Janice: Yeah, it has definitely been meaningful. [00:56:00] One of the learnings that I found out as I was applying to the fellowship, you asked for letters of reference, and so I asked my colleagues at the NCLB for a letter of reference. And as part of that process, they went in and they did the research, bless them, and came back and found out that Ready to Read, which I talked about, in its first year of implementation identified 70, 000 students statewide.

    So that’s 70,000 kids and we all know, there’s some not false positives in there, maybe not all those kids got intervention, but that kind of breadth of impact is, for me, like the red pill moment of policy. I am not going to be able to do that as a practitioner running the practice and the opportunity to have that kind of impact, it’s just something I can’t pass up.

    So I am figuring out what that looks like. I don’t [00:57:00] know what the next step is, but I’m definitely exploring and interested in other policy opportunities to use my expertise as a healthcare provider and education advocate, a parent, and human to try and have a positive, bigger impact.

    Dr. Sharp: Kudos to you for cracking the code a little bit. I feel like a lot of us got into this field to “help” people and always are looking for ways to do that on a bigger scale. You have found a way to do that and that’s pretty admirable. So I’m very grateful that you’re willing to come on and share your experience with this whole journey.

    Dr. Janice: Absolutely. Thanks so much. It’s been great talking to you.

    Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode, always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes [00:58:00] so make sure to check those out.

    If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcast.

    If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting.

    If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call, we will chat and figure out if a group could be a good fit for you. Thanks so much.

    [00:59:00] The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis or treatment.

    Please note that no doctor-patient relationship is formed here and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with an expertise that fits your [01:00:00] needs.

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  • 471. From Psychologist to Legislator w/ Dr. Janice Lepore

    471. From Psychologist to Legislator w/ Dr. Janice Lepore

    Would you rather read the transcript? Click here.

    My guest today, Dr. Janice Lepore, had the opportunity to spend a year in Congress as an APA Congressional Fellow. She’s here to share her experience during that year, as well as the path that led to it. If you’ve ever dreamt of “doing more” as a psychologist, this episode is for you! These are just a few topics that Janice and I discuss:

    • Janice’s personal experience with legislation and activism prior to the fellowship
    • The daily life of a Congressional fellow
    • Surprises from her time in Congress
    • Ways for all of us to get involved if we can’t work in Washington, DC for a year

    Cool Things Mentioned

    Featured Resources

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    I’ve partnered with At Health to offer CE credits for podcast episodes! Visit this link to access current and past episodes available for CE credit. You can use code “TTP10” for a discount on ALL the course credits you purchase from At Health!

    About Dr. Janice Lepore

    Janice Lepore is a Maryland licensed psychologist who has provided assessment, therapy, and consultation services in schools, hospitals, clinics, and her own private practice for the past 20 years. Over the past decade, she has also been engaged in local and state-level policy and advocacy, addressing issues related to mental and behavioral health, education, disability access and inclusion, and health equity and access. In 2023 Janice was selected as an APA/AAAS (triple A S is how that’s usually said) Congressional Fellow and placed her practice on sabbatical to spend a year embedded with the Health Policy team at the US Senate Committee on Finance.

    Get in Touch

    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

    Ready to grow your testing services? Click below to schedule a complimentary 30-minute pre-consulting call!

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  • 470 Transcript

    [00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

    Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code ‘testing’.

    Thanks to PAR for supporting our podcast. The BRIEF2A is now available to assess executive functioning in adult clients. It features updated norms, new forms, and new reports. We’ve been using it in our practice and we really like it. Learn more at parinc.com/products/brief2a.

    Hey [00:01:00] folks. Welcome back to the podcast. Glad to have you. Today is an EHR review episode. I haven’t done one of those in a while. There are some new EHRs breaking onto the scene and I wanted to review one of those today- Owl Practice. I’ve been hearing really good things about Owl Practice in comments and Facebook groups in the mental health world, so I thought I would check it out.

    As usual with these EHR reviews, I think it’s most helpful to go watch the YouTube video. So there’s a, I think about 30 minute YouTube video where I am walking through Owl Practice and showing you all the features and commenting as we go along. The video is definitely going to be more robust, but I think you can gather some impressions from the audio as well.

    As we head into the last part of 2024, it is time to announce new cohorts for The Testing Psychologist mastermind [00:02:00] groups. We’ll be starting in January with new cohorts for beginner, intermediate, and advanced practice groups. If you’re interested in joining one of those coaching groups, you can reach out at thetestingpsychologist.com and we can talk about whether it’s a good fit and decide which group might be right for you or if none of them are, and then we’ll talk about other options.

    All right, without further ado, let’s talk about my experience with Owl Practice.

    Hey folks, I am here to do another EHR review for you. If you haven’t checked out the other videos in the series, I’ve done an entire playlist on EHR reviews. I think we’re up to maybe, I don’t know, 7 or 8 EHR systems at this point. The way that I approach these EHR reviews [00:03:00] is digging in as a new user. So this is not meant to show the in-depth functionality of the EHR beyond a first pass when you first sign up. I’m looking for what is easy to do out of the box, user-friendliness, user interface, features that are specific to testing psychologists, that kind of thing.

    Our EHR today is Owl Practice. If you haven’t heard of Owl Practice, I think it’s a lesser-known EHR, but the comments that I’ve seen about it are almost universally positive. I wanted to dig in and see what Owl Practice was all about.

    As you can see, we are here on the home screen. This is the first thing that you see once you have done the initial setup of Owl Practice. I want to say, I enjoyed the initial setup. It’s a four-step process when you first log into the system and it forces you [00:04:00] to put in the crucial information to even be up and running to get started with the EHR. I really like that. It took 10 minutes. It asked for things like your practice info, your license number, and your clinician information. It has you set your availability and that also has you set your services and CPT codes right from the beginning.

    Now, a comment right off the bat that I did not love was that the language, as you will probably see in this demo, is very therapy-centric. This is a problem that comes up with a number of EHRs but something that I noticed as a psychologist who’s only doing testing, I think it’d be really easy to change the language where it says practitioner or clinician. I don’t know why EHR would choose therapist as the default and alienate a whole group of practitioners, but so it goes, I’m splitting hairs you might say, [00:05:00] but I noticed that kind of thing.

    Otherwise, the onboarding process was great. The CPT codes that they had by default were, of course, therapy codes, but it was very easy to change those two testing codes right there in the window. I think I should be up and running as far as services and CPT codes.

    This is the first screen that you see when you log into Owl Practice. You’ll see right here, even with this little announcement, I think this is an indication of how much our Owl Practice pays attention to onboarding. They are very keyed into prompting you for specific features and letting you know about the different functionality in the system.

    This is just one example that… I can’t show you the email sequence, but when I signed up for Owl Practice, it initiated a five-day email sequence all around onboarding. Each day they give you a little bit more information about crucial features and prompt you to set up those [00:06:00] features and give you resources from their help section on how to learn about those features. I found it pretty cool. It’s a different way to do onboarding that I’ve seen with some EHRs and it was helpful.

    All right. Here we are in Owl practice. Oh, we have this as well. You get a $25 credit if you refer someone.

    Pricing. People are going to be wondering about pricing. Let’s talk about that. It is very affordable. I’ll be honest. The starter version starts at $25 a month. The core version is $39. And then I think most folks are going to go for the pro version because it has most of the features or all the features that I think most of us will need. And that is $49 a month. So very affordable in the EHR landscape. If you’re not billing insurance, you might be able to get away with the core version of [00:07:00] $39 a month, but you need to upgrade to that pro version to get integrated insurance billing and claims.

    Here we are. Again, just first impressions. I like this. This looks relatively clean. I like the UI. I pay a lot of attention to fonts, colors, branding, and that kind of thing. I do like the UI. It is, like I said, pretty minimalist, and pretty straightforward. I like this little pop of color over here to upgrade the plan. That’s a little sales technique, of course, to get you to consider that. So I’m going to walk through some of the core behaviors or functions that we need and see how that goes.

    Right off the bat, let’s see. I like the calendar here. It’s pretty easy. I have to dig into the settings again, splitting hairs, but I don’t like starting a week on Sunday, I want Monday to be the first day of my [00:08:00] week, but it looks like it’s got the typical features. You can get back to today if you want, you can refresh. Sync- I’m curious what that does. Export- I’m also curious about that. The navigation is pretty easy, a little bit of a lag there, but not a big deal. And you can see the open spaces here. This is the availability that I set in the onboarding process. It goes from 9 to 5 each day. I do wish maybe there was a way to show the entire day all at once. I prefer that versus having to scroll, but we will see.

    Let’s try to schedule an appointment. Let’s say that I needed to schedule this yesterday. Event type, client, personal, unavailable. I like this feature. You can set specific types of service. We [00:09:00] don’t have any clients here. That is a comment right off the bat. I wonder what it’s going to do here.

    We’ll just say we want to do a test client. I want to see if I can walk through it. Oh, there’s no therapist either. Interesting. I did put my information in. So this is curious. That’s not letting me populate. I don’t love that. I would love buttons right here to just go ahead and add a new client and, or a new therapist in order to create that appointment. So let’s cancel this. It looks like we might need to go in and create some new clients.

    Ooh, I definitely want to look at this. They have a waitlist feature that could be very valuable for a lot of folks. I’m assuming this is the [00:10:00] add a new client. I’d like that to be a little more obvious. All right, we will say we want to use this preferred name, January 29th, we’ll make this individual middle age. Good stuff here. Gender identity. It looks like it’s not a dropdown. It is just a freehand typing situation. So you can type in whatever you would like. The same with pronouns. Curious how this is going to populate through the system if you type it freehand. This is great. We’ve got the phone number. You can enable reminders right here. I do like that. And this is interesting. It has the therapist right here, but it [00:11:00] did not give me any options for a therapist on the other screen.

    Client sense. That’s an interesting data point. You can put the referring provider’s name. That’s cool. Some comments here.

    Appointment confirmations. I like this. You can set all the reminders.

    Invoice create automatically or create manually. Okay, great. I like some of those automated features.

    Let’s get back up here. This is just an address. Text Expander there. This is cool. We should be able to run with this client now. I’m checking through.

    Language. I’m presuming you can add other languages in the settings, which is a nice feature, and we’ll allow [00:12:00] appointment.

    Here is the waitlist. This is great. Your services auto-populate into the waitlist. This is cool. You can put people on the waitlist for an assessment intake. I might have to test that out in a little bit more detail here as we go along.

    Add client seems straightforward. I’m going to do add and view just because. It’s going to make me… I’m going to disable the appointment confirmation emails and then we will do add and view. Test the client is here. It gives a little overview. Clinical details, diagnosis, circle of care. That’s interesting. Add contact. Add a link to the account. All right. Got you.

    This is the [00:13:00] financial component. Payment methods. What can we do? I guess we can edit maybe. And medications. Interesting to have a separate medications tab. Okay. So add. That’s add appointment. I’m guessing this is just add… No, that’s add to do. Where am I? Oh, the add button is down here. I don’t know. This is not super intuitive to me, but we will keep rolling.

    With the edit button, the edit button is down here, I am going to go ahead and add a diagnosis. Let’s go ADHD combined. This should be good. All that looks pretty straightforward. We [00:14:00] have saved the client. We have a diagnosis input. I’m going to go back to the calendar and let’s see if we can now create an appointment for yesterday.

    Client. Here we go. It’s going to auto-populate the clinician. So you presumably set the clinician in the client screen. All right. Great. Service. We’re going to go ahead and say assessment intake. It does not recur. Here we go. We have created an assessment intake. I like this. It’s nice and bright. It tells you what the service is. Now, true question. Can we move it around? Oh yes, we can. Ooh, the session is invoiced. Please try again with an uninvoice session. I like this. So now we’re going to click in. It has been charged. [00:15:00] This is good. It’s just telling us that it’s charged. I wonder what happens when we click this. Nothing. It just includes the fly-out right here but it is attended. We can record payment right from here. Let’s go ahead and view that invoice and see what happens.

    Let’s take a break to hear from a featured partner.

    Y’all know that I love TherapyNotes, but I am not the only one. They have a 4. 9 out of 5-star rating on trustpilot.com and Google, which makes them the number one rated Electronic Health Record system available for mental health folks today. They make billing, scheduling, Note-taking, and telehealth all incredibly easy. They also offer custom forms that you can send through the portal. For all the prescribers out there, TherapyNotes is proudly offering ePrescribe as well. And maybe the most important thing for me is that they have [00:16:00] live telephone support seven days a week so you can talk to a real person in a timely manner.

    If you’re trying to switch from another EHR, the transition is incredibly easy. They’ll import your demographic data free of charge so you can get going right away. So if you’re curious or you want to switch or you need a new EHR, try TherapyNotes for two months, absolutely free. You can go to thetestingpsychologist.com/therapynotes and enter the code testing. Again, totally free, no strings attached. Check it out and see why everyone is switching to TherapyNotes.

    Our friends at PAR have released the latest addition to the BRIEF2 family. The BRIEF2A lets you assess your adult clients with the gold standard and executive function. It was developed with the three-factor model from the BRIEF2, which characterizes executive functioning deficits more clearly. It also offers updated norms, new forms, and new reports. Learn more at [00:17:00] parinc.com/products/brief2a.

    All right, let’s get back to the podcast.

    Okay. I like this. I was concerned it was going to take us away from that screen but it creates a pretty simple invoice. Appointment is not yet scheduled. Balance due $250. Great. So you can email the client. I’m guessing it will auto-populate if we put in an email address. You can password-protect it. That’s an interesting feature. That’s kind of cool. All right, great. And let’s see what else we got. We can close out of this and be right back here, which I like.

    Payment actions. Let’s go ahead and record a payment and see what that looks like. We’re going to say credit card, amount paid $250. Now, is it charging the [00:18:00] card? It can’t because we haven’t put one in, but we’re going to record this payment. Okay. Awesome. So now it shows you that you have paid. Invoice auto creates an invoice and takes you to the screen if you want to send a receipt. It’s kind of cool. All right. Nice.

    Let’s see how it handles units. Let’s say we did some testing with this individual. Here we go. We’re adding our client. We’ve populated. Therapist service- we’re going to say we did some testing. Now, how do we create an add-on? I’m going to create this session. [00:19:00] How do we create an add-on folks?

    All right. So clearly something, if you mark the session as attended, that locks it to some degree, but you can still create the note. So I’m going to go back to our intake and try to create a note here. So intake assessment note, I’m just going to work off this template. See what this is. This is clearly therapy intake notes. I don’t know if I love this format, all these dropdowns of very specific symptoms.

    Oh gosh. No, no, no, no, no, no, no. We’re not going to be doing that. I don’t know if I love these notes. This just feels like a lot of typing and a lot of manual work to do. Hopefully, there’s [00:20:00] a way to change that. I do like all these features off to the side. So let’s close that.

    All right. Now, as far as this appointment goes though, how do we do an add-on code? I’m not seeing an option for an add-on code. And that’s going to be a problem for us and some other services. Just a note. And then, finally, we’ll go in and we’ll create a feedback appointment just to round out the whole process here. I’ll go ahead and create that.

    Let’s go ahead and click through some more options. Let’s see what workflow [00:21:00] does. We’ll circle back.

    So workflow, it looks like there’s, okay, this is kind of cool. Maybe this is a to-do list. Tasks. It’s not exactly a to-do, but what happens when you click on these notes? Yes, it does give you the notes that you have to write. So this is kind of cool. I like this. It’s sort of like a unified to-do list. And then you have specific options here that you can use.

    Let’s see what the dashboard function is. This is mostly financial it looks like. We got revenue per session. That’s cool. Discount sessions. So you can see it’s populating here in October we’ve got one session. [00:22:00] Year over year. Practice stats. I love a good graph. Projected total sessions. Discount. This has given you a decent little dashboard to track, and looks like, yes, you can export these if you want to manipulate them. You can go by the therapist. Therapist grades. Ooh. Okay. So this is cool. I like this. I love a good dashboard. Clinical stats, client demographics, forms, measures, medications, and client tags. Oh, waitlist count. This is cool. This is a relatively robust dashboard in Owl Practice. I like that you can export all this. Okay, nice.

    [00:23:00] Let’s see what manage is. This is the only thing… These three options and settings are a little confusing to me. They seem to overlap. It’s not immediately apparent what each one does, but I’m sure you can learn that.

    All right. So you’ve got your forms in here, which is cool. They’ve populated. Let’s see what happens if we edit the intake form. So it’s got a basic form editor. I wish this was bigger so I could see what the actual question is, but yeah, a basic form editor. You can add a different thing. Wait. I thought that was a dragging situation. It is not a dragging [00:24:00] situation.

    How do I put these things into the form? I’m not sure if this is a function of maybe the trial that I’m doing or what, but I would love to add. I’m trying to double-click. Okay. That’s interesting. I can’t figure out totally how to make those fields go in there. Suffice it to say though, you could do that somehow. So you can edit all your forms. That’s cool.

    Measures. Let’s check out the measures. They have a bunch of built-in outcome measures and other kinds of things. Is there a search? I mean, this is a lot of measures. That doesn’t work. I’m not sure this is a global search box for the EHR. [00:25:00] So I’m going to just scroll through. Lots of publicly available measures.

    Handwritten notes. That’s interesting. I’m not sure what that might be. Note templates. So you could, yes, I’m assuming you can create your own. I’m not going to go through this process, but I will just jump in and see what this looks like. Again, how do you do this? Oh, it just jumps in there. Oh, that’s interesting. You can see you just click on it and it shows up.

    Dynamic content from client profile. I like this. So these are dynamic fields that are going to pull automatically from the client. I could see this being a pretty cool option to build your forms, but of course, you would have to do that.

    [00:26:00] Practice documents. I’m not sure what this is exactly. I’m guessing it’s handouts, worksheets, and things like that that you might share with clients.

    Let’s look at this. Tons of settings. Practice logo. You can adjust the size. It’s neat. This is all the multi-factor off. Calendar colors. I love being able to manipulate colors. Financial documents. Customize your invoice. Room Booking. Cool. If you need that feature. Tags- you can add client tags and search for them. Insurance profiles. So this looks like it works for Superbills. And then, yes, you have to upgrade if you want the in-network billing features. Therapist settings. Okay, just a lot of settings [00:27:00] here to set permissions and so forth. And then, of course, admin settings.

    Locations. We have one location here. We could add more. This is a user situation. I would think I would be an administrator but maybe I need to add that. I’m guessing you could add it here. Or maybe this is for your actual administrative staff. All right. There I am as a therapist. 

    Therapist grades. I”m not exactly sure what that might be.

    Services and fees. You can see we already input a lot of those. You can add more here.

    The Client portal. So definitely a client portal. You can configure all sorts of settings right here.

    [00:28:00] Forms. We dipped into a little bit. It looks like these are the forms that are available on the client portal and the messages that go out to the client from the client portal. Form reminders, clinical measures messages, clinical measures reminders. I like that you can customize these things. I really do like that.

    The client portal homepage. They have online booking. You can select all kinds of options for allowing clients to book into the portal. That’s great. Payment details. Interesting.

    Cheque. This must be a Canadian company is my assumption. I think that sounds familiar now that I’m thinking about it. The cheque with the que is [00:29:00] tipping me off and then the selection of French as the language.

    Notifications. This is great. Okay.

    Client reminders. It looks like you can customize these to some degree or can you? It looks like you can’t do it by appointment type, unfortunately, but you can customize the message for confirmations and reminders.

    Secure messaging. Cool. So you can do secure messaging either in the office only between your staff or with clients as well. Clients can message any therapist or know their assigned therapist. Office admins can message clients. Cool. Users. You can set permissions there and then subscription I’m guessing this is yes.

    I’m on the free trial. FYI, you can do a free trial for two weeks without putting in a credit card, which I think [00:30:00] people appreciate. And then billing is going to give you a summary of your billing. Help is going to go to their help section.

    Sync, what are we doing? We can do a Google Calendar Sync with Google. It does do two-way sync with Google and it looks like other calendars as well. This is the privacy mode. So you can see… What can you see? What did that do? Oh, okay. It gives the initials here. It eliminates the name, which is nice.

    It takes a little bit to load. Just slightly annoying.

    Recently viewed. It’s my clients. Oh, there you go. You can add a client right there. Upgrade plan, Email help, tutorial, sign out. Great.

    What are the settings here? We can hide if you don’t work on weekends. [00:31:00] You can set your calendar interval. I’d probably put that at 30 minutes start time. I wish we could do a week start time, but so it goes. Let’s see. Just a little UI issue here. Looks like you can’t apply these or maybe it’s because this is overlaid. Maybe it’s just the window size, but that’s a bummer.

    All right. What is this button? I’m just clicking buttons y’all. I’m not sure how that’s different from the day view but there you have it. You can do week, month. Your appointment shows up like that. I like that.

    I like Owl. Generally speaking, there’s a [00:32:00] lot to like here. The setup is pretty clean I think. I found the navigation to be relatively intuitive. I think with some time you can certainly get more familiar with these options over here and how to navigate through the software. I like that you got a clean calendar here and I think would look even cleaner if you could reduce the interval there so it’s half an hour instead of 15-minute blocks, that lengthens the calendar. You can move things around, and change the appointment time just by dragging. So that’s all good. All this stuff is pretty straightforward. I think this is a pretty familiar calendar layout now for most EHRs and that’s a good thing. Some privacy mode up there, which I like. Easy to add a client and easy to search. This is cool. You can [00:33:00] search a lot of different fields with this box. Otherwise, the settings are pretty easy to navigate. I like the onboarding. It’s a generally clean system.

    Things that I don’t love at least at this point.

    The language, like I said, the ability to do add-on codes; I didn’t see an easy way to do that. I’d have to poke around a little bit more and see how that might work. I’m guessing there’s a Help article on it.

    What else? Just little, nitpicky things here and there. It takes a little bit to load when you click into different calendar screens and I’d love to have customizable reminders dependent on appointment type, little things like that.

    All in all, if I could figure out the add-on issue and make sure that that works, [00:34:00] then I could consider Owl as an option for testing psychologists. You have customizable forms, you have inclusive language options in the client screen, and a lot of outcome measures as well. The dashboard looks cool. I’m just reflecting on some other things that I liked about it. I’d say the downsides, at least at this point, are relatively minor with that big asterisk of making sure that you can set up add-on codes and bill for them.

    I hope that you enjoyed this review. I hope it was informative and helpful. Go check out the other EHRs if you are considering an option for your practice.

    All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes. So make sure to check those out.

    If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or [00:35:00] Spotify or wherever you listen to your podcast.

    And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist Mastermind groups. I have mastermind groups at every stage of practice development, beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.

    [00:36:00] The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional psychological, psychiatric, or medical advice, diagnosis, or treatment.

    Please note that no doctor-patient relationship is formed here and similarly no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

    Click here to listen instead!

  • 470. EHR’s for Testing Psychologists: Owl (Basics)

    470. EHR’s for Testing Psychologists: Owl (Basics)

    Would you rather read the transcript? Click here.

    Hey everyone! Given all the questions about EHR’s (electronic health records) in the Facebook Community and among my coaching clients, I wanted to take a few episodes to dive in to some of the major players in the EHR space. Each of these reviews will focus primarily on the testing-specific aspects of each EHR, though I’ll also do an overview of non-testing features that are important. 

    For the FULL review experience, check out the accompanying video on the Testing Psychologist YouTube channel. Enjoy!

    Owl Practice is the star EHR for today. It’s a relatively new EHR that’s getting a lot of great reviews. Here’s how my review broke down:

    Pros:

    • Free trial, no credit card required, with customer support
    • Daily email series to onboard, plus a dedicated practice setup consultant
    • Set your availability and services/fees right up front during onboarding
    • Competitive pricing
    • Inclusive language
    • Waitlist feature built in

    Cons:

    • Language: “therapist”
    • Calendar and other screens take more time to load than I’d like
    • Can’t customize reminders based on appointment type
    • Note customization is clunky
    • Couldn’t figure out how to bill add-on codes or additional units

    Takeaway: assuming that you can bill for add-on codes and multiple units easily, I would certainly consider Owl as an EHR. There are some nitpicky problems, but it’s a viable solution with a great price point.

    Cool Things Mentioned

    Featured Resources

    I am honored to partner with two AMAZING companies to help improve your testing practice!

    PAR is a long time supporter of the Testing Psychologist podcast, and I will continue to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

    TherapyNotes is the leading EHR system for mental health practitioners. I’ve used TherapyNotes for over 10 years, and it just keeps getting better. Use this link and the promo code “testing” to get two free months and try it for yourself! www.therapynotes.com/testing

    The Testing Psychologist podcast is approved for CEU’s!

    I’ve partnered with At Health to offer CE credits for podcast episodes! Visit this link to access current and past episodes available for CE credit. You can use code “TTP10” for a discount on ALL the course credits you purchase from At Health!

    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

    Ready to grow your testing services? Click below to schedule a complimentary 30-minute pre-consulting call!

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  • 469 Transcript

    [00:00:00] Dr. Sharp: Hello everyone and welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner and private practice coach.

    Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.

    This podcast is brought to you in part by PAR.

    Hey, guess what y’all, the BRIEF-A has been updated. The BRIEF2A is the latest update to the BRIEF2 family. Use the gold standard in executive functioning assessment to assess adult clients. You can preorder it now, visit parinc.com/products/brief2a.

    Hey folks, welcome [00:01:00] back to the podcast. I’m glad to be here with you as always. As always, I’m glad to have my guest today. I am talking with Diana Heldfond, who is the Founder and CEO of Parallel Learning, a technology-forward education company.

    I’m also joined by Dr. Jordan Wright, Parallel’s Chief Clinical Officer, as well as the Director of the PhD Program in Combined Clinical and Counseling Psychology at New York University. You may not recognize Diana’s name, but I’m sure you recognize Jordan’s name as he has been on the podcast several times before and is generally everywhere in the assessment world.

    This is an interesting episode. I wanted to talk to Diana and Jordan, who I met independently, but I was thrilled to hear that they were working together a while back. I wanted to talk with them about Parallel because Parallel is a fascinating company that’s pushing the envelope with telehealth assessment and [00:02:00] access for a number of school districts around the country.

    So we talk about the origins of Parallel and how it’s serving a crucial need for these districts, we talk about the current state of the research on tele-assessment, how Parallel is leveraging technology in assessment, which is fascinating; I think that many of you will take a lot away from that section of the conversation, and what it’s like to be a Parallel provider for those of you who may be interested in going down that path.

    As always, there’s a lot of good material here and I had a great time chatting with Jordan and Diana about Parallel. So without further ado, let’s jump to that conversation.

    Diana, Jordan, welcome to the podcast.

    [00:03:00] Dr. Jordan: Thanks for having us.

    Diana: Thanks for having us.

    Dr. Sharp: Glad to have you. Jordan, you’re a frequent guest. It’s been a little while, and this is your fourth time, maybe and Diana, it’s been a while since we chatted so it’s good to reconnect with you and have both of you here at the same time. I’m excited to talk about Parallel and what you’ll have going on over there. Thanks again for being here.

    I’ll have y’all start just to orient the audience a little bit to your voices, do a brief introduction, tell us what you do there at Parallel and we’ll go from there. Diana, you want to go first?

    Diana: Yeah, I’m happy to start. First off, thank you for having us. I was saying to Jordan earlier today, before I had ever fully started Parallel and dug in, I remember watching a video of you guys chatting on your podcast. So it feels very exciting to have that come full circle and to now be on the [00:04:00] podcast together.

    I am Diana. I am CEO and Founder here at Parallel. I started the company about 4 years ago, very much driven from my own experience. I grew up with learning and thinking challenges. So I fall into the population of students we now work with here at Parallel and lucky to work with folks like Jordan. I’ll let him do his introduction.

    Dr. Jordan: Thanks. I’m Jordan Wright. I am going to pre-apologize to your audience because they’re probably sick of me by now. I am the Chief Clinical Officer here at Parallel. I oversee all the clinical programming. I’m an assessment psychologist. That is how I identify and work a lot in this space. I write a lot in this space.

    Also similar to Diana’s story but a little bit divergent is I was diagnosed with ADHD but very late. I wasn’t diagnosed until college. And [00:05:00] so my drive for working with neurodivergent kids and providing better access and better resources for kids is to help them have more of a Diana experience where she was identified much earlier and got all the supports she needed and then succeeded in life.

    I struggled for a lot longer than I probably needed to, and that’s why I was excited to join Diana on this this little experiment, this little venture that we have going at Parallel.

    Dr. Sharp: It’s amazing […] from experiences.

    Diana: Not so little anymore.

    Dr. Jordan: It’s a big experiment now.

    Dr. Sharp: It seems like it’s gotten pretty big. That’s a good way to put it. There’s a lot going on here that I’m excited to chat about. Yes.

    So that’s a good segue, let’s talk a little bit about Parallel for any folks out there who may not know what parallel [00:06:00] is. I’d love to start there; tell us a little bit of the origin story and what y’all do, how it’s relevant to assessment.

    Diana: I’ll start and then let Jordan fill in the blanks, but I can definitely touch on the origin story. As I mentioned and as Jordan mentioned as well is that I was lucky enough to be diagnosed with ADHD and dyslexia, not lucky to be diagnosed, but lucky to be diagnosed in the sense that I was 7 years old when I was diagnosed.

    So I had the best-case scenario since I reaped the benefits of early detection, early intervention for those conditions, had access to a ton of resources. My parents were very on top of getting me support and care, teachers as well who were involved and had what is considered gold quality of care and recognizing that that is not the norm for most students across the United States who might be years [00:07:00] behind in core academic subjects before anyone intervenes on their behalf.

    I was super motivated to rethink how we could literally recreate my own experience, my own story for more students and help get this personalized care for students when they need it most, and that means intervening early, it means different care for different students and so that was how Parallel came to be.

    My background is very much on the business finance side of things, which is why I teamed up with Jordan and the rest of our team has been built around bringing minds together from all different walks of life to make sure that we are building the best possible program for students of all different needs and backgrounds.

    A little bit more concretely what that looks like; we work exclusively in K-12 school districts at this point, a little bit of the county cooperative level so on as well, but always working within a public school systems and [00:08:00] helping support students through a host of different special education resources.

    So everything right now from assessment all the way through to behavioral mental health coaching, we’re also doing specialized teaching, specialized instructions, a small group intervention for students who might need a little bit of extra support when it comes to reading, writing, Math so on, and then speech and language therapy, so both assessments and ongoing therapy for students.

    So we’re touching all different walks of what is the bubble of special education but with the goal of making it much easier for school districts to meet students where they’re at and ensuring that kids get access to not just the resources they need, but super high quality care, no matter where they’re located in the United States.

    Jordan, I’m sure you have a lot of other things to add, so I’ll pass it to you.

    Dr. Jordan: Yeah. I’ve talked on the podcast before about my background with tele-assessment. The [00:09:00] reason that I started researching tele-assessment was because of access. I was driving 3.5 hours to Upstate New York to assess a kid who didn’t have access to a psychologist or school psychologist, to do an evaluation, and then doing the evaluation and driving back. And in that amount of time, I could have done 3 evaluations.

    So I decided to jump into the research side and think about what is valid, what is ethical and do some more systematic research to decide, especially for performance-based testing, our IQ tests, our academic achievement tests, those sorts of areas, what is valid and what is ethical. And from there, I published some research that no one cared about until 2020, when it became very sexy for some reason.

    Dr. Sharp: It’s weird.

    Dr. Jordan: Something happened in 2020.

    Dr. Sharp: Coincidental, I’m sure.

    Dr. Jordan: Exactly. And then there was the scramble. And with Susie [00:10:00] Raiford, we wrote the book on tele-assessment; Essentials of Psychological Tele-Assessment.

    Our company is entirely virtual. We’re entirely remote. We are partnering with schools and school districts to upstaff them, to upskill them, to make sure that they have better resources to meet the needs of all those kids whose needs are going unmet.

    I know we’re probably preaching to the choir with your audience here, but so many schools are out of compliance. So many schools are not able to tackle the evaluations, the support services that are required of them through IDEA, through the IEP Plans and need better and more resources. And that is our goal.

    Our goal is to push in and provide those resources. Licensing is a bit tough at state by state, we’re working to try, within the states we’re working in to be able to dispatch the [00:11:00] best possible providers to match with those kids who need them.

    I told Diana from the beginning, I was a terrible hire and she shouldn’t hire me. I’m going to eat into our margins and all that kind of stuff from a business side, because we’re also trying to do it well. We’re trying to maintain the good quality and do all of the work in alignment with the research that I’ve done and other colleagues have done and make sure that it’s not the Wild West that was out there during the lockdowns of the pandemic where everyone was doing the best they could do, but it was not necessarily in alignment with what the research shows is valid and ethical. We are trying to maintain that quality in all the work that we’re dispatching to these schools and school districts.

    Dr. Sharp: I think it’s super cool. When I saw that you were involved with Parallel and knowing what I knew just from talking to you, Diana, a few years ago, it was a really nice moment. I was like, [00:12:00] okay, this is going to be amazing. It’s a cool partnership.

    I’m curious, before we dig into the state of tele-assessment, I definitely want to talk about that and where we’re at now, but just from a business perspective, I’m curious how much of this was driven by COVID in a sense, especially I think a lot of us heard schools got completely overwhelmed and that delay in being able to assess and provide services during the pandemic set the calendar completely crazy for a lot of schools and ended up with this avalanche of assessment. Do y’all have a sense of what role that played in being able to build a business like this?

    Diana: Undoubtedly a large role. As Jordan pointed out, to be fair, his research was very well-known before but it did [00:13:00] spiral to fame after COVID. I would say that COVID was a big moment for education world, because it forced schools to look at other options to problems that probably existed or did exist prior COVID.

    If you look at special education world, not just school psychology, but all of these different providers, it’s hard to do exactly what the purpose of special education is, which is to provide very personalized learning, which is why those services are also aggregated at the district level instead of the school site level.

    When you think about a rural district in U.S., one school site might be 50 miles from the next and that provider, just as Jordan mentioned himself, doing at one point is going to be spending more time driving than actually seeing students.

    In each school site, you’re going to have a handful of students who need totally different things. So they’ll actually run a system, COVID aside, to provide the [00:14:00] students with exactly what they need. It’s just a really tall aspect.

    And so I think that COVID was a good turning point in the sense that it allowed districts to start looking at the different options. Teletherapy has been around far before COVID. It’s not like this all of a sudden happened during COVID that people started putting these things online, but it did make schools more receptive.

    On the flip side, psychologists themselves and other providers are more willing to at least try to put things online, try to deliver services and look at that as actual long-term solution instead of a stopgap solution. I would have felt like the credentials that are needed of a special education teacher, a school psychologist, and so on is so vastly different than a regular teacher in the district in the first place that there’s always been super high turnover, huge access problems when it comes to special education as a whole that we’re only further exacerbated during COVID.

    We very clearly [00:15:00] saw districts during COVID who had all of a sudden waitlists of thousands of students who needed evaluations. We still see districts who are trying to make their way through compliance issues that they’re are dealing with after COVID.

    I would say COVID is a huge turning point, a huge catalyst for us diving in to this business at this exact point in time but that isn’t to say that the problems didn’t exist pre-2020.

    Dr. Jordan: I would double down on that. It’s not like every school was compliant before COVID and now magically, no one’s compliant. We all know that they were just as out of compliance back then as they are now. I think of COVID as almost like a proof of concept.

    I know early on during the lockdown, people were doing this as the best possible stand-in but it ended up [00:16:00] showing schools, school districts and providers, psychologists, SLPs and others that this can work just as well, if not better in certain circumstances than traditional in-person services. So that proof of concept wasn’t there before.

    I think COVID gave us a PR push to think about teleservices even though, as Diana mentioned, the literature was there and pretty strong, especially for teletherapies and virtual education. It wasn’t as strong for tele-assessment. That came in the few years right before the pandemic and then that research became very hard to do during the pandemic because we had no control groups. We couldn’t compare it to assessment as usual.

    Now, both psychologists and schools are understanding that this is not just a good enough fill in [00:17:00] until we can get in-person services, this is a viable alternative that could improve the ability to tailor services to exactly what kids need in the moment.

    Dr. Sharp: Sure.

    Diana: Maybe to add one point to that as well and to go back to the original question, Jeremy, I think COVID was a really good instigator for starting a business that has a large software component, which is what Parallel does.

    I will highlight Jordan’s work as not just our chief clinical officer, but operates like a chief product officer as well in many ways, because as he pointed out already, this world is the Wild West or certainly was during COVID. Everyone was trying to figure out how to do assessments on Zoom in the best most effective manner.

    There’s a lot of room to Jordan to make these services not just on par with, but in some cases better than what students are going to get in an [00:18:00] in-person setting. Especially, more and more new generation of students are digitally native students, so in many cases, for them to work through teletherapy, putting assessment aside for a second, there are ways to engage students in a virtual setting that, at this point, it’s probably better suited to the way that they ingest information and develop skills than they would in an in-person setting.

    So it was a great opportunity for us to dig and think about what are the ways to, not just do this according to the research and by the book, per se, especially on the assessment side. Also, how do we think about further engaging these students using the results from the assessment to think about what is it specifically that this student needs and what can the district specifically do and how can we equip the other teachers that are supporting a student to provide exactly what that student needs.

    Dr. Sharp: Yeah. I’m excited to get into all these [00:19:00] components. There’s a lot going on there. When we were thinking about how to structure this conversation, you thought about this idea of, you call it 3 buckets or 3 main areas that we might touch on; tele-assessment, the partnerships with the schools and then what you’re calling tech enablement, which all sound fascinating.

    Maybe we start with tele-assessment because, we’ll see, I was about to say that’s the broadest, most applicable topic for everyone out there, but that may not be true, the tech part might be interesting too for everyone.

    Let’s start with a tele-assessment. I admittedly in our practice has not done a ton of tele-assessment since the pandemic but a lot of people are. I am talking about this like at least weekly with folks in consulting and podcasting and stuff. I’m curious, what is the state of tele-assessment research at this point? [00:20:00] We can take that into the practical components as well.

    Dr. Jordan: It’s a great question. I can nerd out about it forever so I’m going to try and keep it succinct to spare Diana, especially.

    The state of tele-assessment research has not grown or shifted all that significantly since we published the book in 2021. There is not a lot of brand-new research coming out, and the research that does come out is pretty much confirming what we already knew. So it’s reaffirming and confirming what is valid, what is not valid; what is doable, what is not doable.

    We all know that we’re not going to be able to do an ADOS completely remotely, bubbles through Zoom look different than bubbles in-person, and playing with a little money is tough on online. So the ADOS as it currently [00:21:00] stands, it’s just not going to be doable. That doesn’t mean we can’t use a whole host of other measures, methods we know.

    I worked with some colleagues who are much smarter than I am 2 years ago to publish a paper called Evidence-Based Clinical Psychological Assessment in Professional Psychology Research and practice. I’m very proud of this paper because what it does is it shows the current state of evidence when it comes to assessment and it reminds us not to put too much stock in any one test, measure or method.

    The best evidence practice is to triangulate across different methods, across different informants, and make sure that you’re understanding the limitations of everything we’re doing. Every test that we care about in psychology, I lump into 1 of 3 buckets. They are either looking at abilities like our academic achievement tests, our executive functioning tests, our [00:22:00] IQ tests.

    They’re looking at traits. The way I define traits are the way you interact with the world that is relatively stable across context and across time. And these are our personality measures. Our MPMIs, our NEOs, especially, these sorts of personality things.

    And then it’s looking at functioning. The 3rd bucket is functioning and that’s, how are you doing socially? How are you doing symptom-wise? What are your coping mechanism strengths? What’s happening for you right now?

    Everything we look at is a proxy. I can’t put you on a scale and tell you how narcissistic you are or take your blood and tell you your verbal ability. Everything is a proxy. Everything has error. So if we’re introducing maybe a little extra error, then we need to take that into account and that tends to be what all of the new research is reconfirming for us when it comes to tele-assessment.

    Probably the biggest advance in tele-assessment is coming [00:23:00] with new measures and methods. When we think about those new measures that are coming out, I gave my first WAIS-5 last week. Susie Raiford, who authors it has created a Nonmotor Full Scale index that is just built in.

    It’s got slightly different subtests that you can give, but it is fully non-motor. It is fully administratable. You can administer it fully remotely online. It’s already built for that.

    When we get the new Woodcock-Johnson V coming out in the spring, it is being fully developed online. It’s on the computer digitally. I shouldn’t say online because it’s not being fully developed really for remote specifically, but it is being fully developed in the digital space.

    And so more and more, [00:24:00] as Diana mentioned, our world is becoming more digital. It’s not going anywhere. Digital education is happening. Our kids are way more digitally native than we are. I’m very old. Especially compared to someone like me, our kids are fluent and they interact with people in this way very naturally.

    So the landscape of tele-assessment isn’t going anywhere. We are going to continue to do the research to validate it and make sure we know what is valid and what is not, what is ethical and what is not. We’re going to keep moving on this. And as new tests come out in new formats, we will test the crap out of those too.

    Dr. Sharp: Sure. So where are y’all at? What does the tele-assessment implementation look like for Parallel? I’m curious because there is so much. [00:25:00] There are a lot of people out there who are doing so much more tele-assessment, like I said, than I am these days, but I feel like the challenging part feels like the performance-based measures, that feels hard. I’m super curious how y’all are implementing this consistently and in a standardized way and so forth.

    Dr. Jordan: It’s a great question because when I think about the work that I do personally, and I have done in my private practice or in my clinic, I think about Zoom, I think about how I can display materials and how it can have fidelity with that.

    The thing that has been super exciting for me that Diana alluded to, I get to nerd out with engineers and product people every single week. At Parallel, specifically, we’ve gotten to design and develop our own platform. So we have our own telehealth [00:26:00] platform that we get to design and develop how we want. We get to build the guardrails.

    We are in a privileged position where we get to partner with and consult with and contract with and thought partner with the Pearson’s and the Riverside’s out there, and the PARs and whoever else. We license the materials directly from our testing partners and build it in, in our platform, that we don’t have to worry about

    is this remaining faithful to the research? Is this remaining faithful to what it would look like if I were there with an easel or with a stimulus book or anything like that.

    We get to build in all of the guardrails and dictate the batteries as well. So that full-scale IQ, if we’re not in a mood, which we’re not, to send blocks [00:27:00] to a rural school and never see them again, those blocks are more expensive than you would think, then we have worked to develop the workarounds to look at the Block Design Multiple Choice and think through what has been validated in this space to replicate that full-scale IQ in an ethical and valid manner.

    We get to help our providers. We get to educate our providers. When they join us, they have to sit through a video of me doing it and showing them how to do this and walking them through what a WISC-V looks like in tele-assessment, what a WAIS-IV, soon a WAIS-V, looks like in the tele-assessment context so that they know how to do it.

    We enable them, we give them the education, we give them the NASPCEs that they need to be able to do [00:28:00] this in the most valid and ethical way. We also then have a robust quality support program. We have an amazing team of focus because it’s on the tele-assessment side of school psychologists, who are on our leadership team and work with us to make sure that they are ready to administer it in a valid way, to make sure that they understand how to use our platform and do everything they need to do to make sure the kids get the most valid results they can get.

    We video record so that we can spot-check and make sure that no one’s getting a little lazy. We’ve all been there. I do it. I get lazy. The more I do this, and I probably phone in some things. I need that check. We all need that check every once in a while.

    We all know the research out there on how many mistakes are happening in IQ tests from licensed professionals. The research shows that [00:29:00] mistakes are happening left, right, and center, hugely rampant in the field.

    And so we spot-check, we make sure we are doing on ongoing quality, we can call it quality assurance, I call it quality support, so that when these psychologists are doing it, if they have a problem, they can always reach out to us for extra support or extra practice, or they’re like, I’ve forgotten how to access the norms for Block Design Multiple Choice, or what this means for a non-motor full-scale score or something like that, they can reach out to us and get support and feedback immediately.

    But also we spot-check them and make sure that they are constantly vigilant about doing this the right way because this is so new to the world. So many of us are just learning this. We didn’t learn it in graduate school.

    There are a few very early career folks who maybe [00:30:00] did learn a little bit of tele-assessment in graduate school, but most of us were having to re-upskill ourselves. We’re having to relearn how to do this in this new virtual space, so we want to be there to make sure they are fully supported in doing that.

    Dr. Sharp: I love that. Just to read between the lines a little bit, it sounds like y’all have created a very cool proprietary platform that nobody else can access that does this really well.

    You’re doing something different, I say that in the most like admirable way possible, but it sounds like y’all are doing something different in a sense than the rest of folks in private practice. You’re not sitting there fumbling with setting up the Zoom set up and the difficulties of tele-assessment that a lot of us have had to deal with over the years in managing materials and what to show [00:31:00] when and how to do it and all that. You built that into a platform, which sounds amazing.

    Dr. Jordan: You were mentioning the 3 buckets, there are three overarching themes that drive the work I do here at Parallel. One of them is access. We’ve talked about that. I want to make sure more kids have easy, quick, immediate, necessary access to the assessments they need to the services they need.

    The 2nd bucket that I think of as driving the work that I do is ease. If we can use technology to make a psychologist’s job easier, we’re going to do it. If we’re going to think about ways to organize the real estate on the screen that helps our providers not get distracted by, oh, I need to open this up in this test publisher’s website and then share that and go back and forth.

    And then I have [00:32:00] a 3rd publisher that I need to, within one platform, we’re trying to make it as easy as possible. This goes for tele-assessment; this also goes for our services. There are so many things that we need our psychologist brains for. When I’m writing a report, I need my psychologist brain to make a conclusion, to make that ultimate diagnosis, to do that.

    There are hundreds of little things that we do not need our psychologist brain for like those tables at the end of reports. So in addition to our tele-assessment platform for administration, we’ve developed a report writer. We’re about to launch Report Writer 2.0, which I’m super excited about, but we’re thinking and of course, everybody’s thinking about what can AI do?

    There are great little standalone products that are out there that are starting to move in that direction. The first place I wanted to [00:33:00] intervene and I get to nerd out with some engineers was, there’s so much error if I have to transfer scores from a score report into my data tables at the end, and then from the data tables to the content, I was like, how can we bypass this?

    So our engineers quickly, easily created a system where any of the printouts that I get from the platforms, from our publishers, from all of these most widely used tests and measures, all I have to do is upload them and they are automatically in our report.

    They’re in our report in tables at the end. They’re in our report in the meat with some rudimentary interpretation of specific scores so that when I need to go in and work on my report, I’ve got a little bullet list of all the things that are measuring verbal skills or all the things that are measuring anxiety from [00:34:00] all the different reporters and they’re right there in a little list, I just have to write my little summary sentence. I just have to use my psychologist brain to reconcile.

    If there are differences in what teachers are seeing, parents are saying, and kids are self-reporting, I need my brain to see that clearly. That’s already done for me. And then make an interpretation. What does this actually mean for this kid?

    So ease is that second thing? And yes, we have built this proprietary platform that not everyone has access to. We’re also iterating on it. We are constantly trying to improve our platform.

    We’re constantly listening to our providers, our psychologists who are using it for testing and hearing what they would think would make it easier and trying to build a better platform so that they can have an easier life and do what they should be doing; focus more time on working with those kids, focus more time on doing the tasks that their [00:35:00] psychology brain needs to be doing.

    Diana: Let me add a quick point there too, one thing that is unique about working with school districts to do assessments is that every school district also has a slightly different expectation of what a report looks like. And so by building technology, as Jordan’s explained, we can help guide the provider to generate a report that is going to be exactly to the school specifications without creating that headache for a provider where every single time they’re working with a different school district, all of a sudden there’s different expectations of them.

    And so that’s the way that we like to think about product is how do we, to Jordan point, make this easier on a psychologist to do their job, to focus on working with that student and think about what the student needs and not all of this headache of the administrative work.

    And then the other part I was going to touch on, [00:36:00] other exciting part is by having this community of providers of all different backgrounds, we also are able to crowdsource in things like interventions that can help different students. And so we are also thinking about how can we integrate the network and community of psychologists and other professionals on the platform to ensure that those reports and then the ongoing care that students are getting are what that student needs.

    We’ve got so many amazing professionals on the platform. We want to be able to give everyone a voice in helping provide guidance to each of their peers.

    Dr. Jordan: And to that point, we’re going to focus more on the testing, because this is The Testing Psychologist podcast, but I talked about two of the buckets that drive me access and ease, the third one, to Diana’s point is innovation. The more we can tech enable especially our ongoing services, the more we can deepen the work [00:37:00] that we’re doing.

    We can think about ways to provide kids with activities and games and more exciting work that can reinforce the work that we’re doing with them one-on-one in a way that is much harder to do in-person. So we are trying to work toward innovating and we collect a lot of data.

    Obviously, I’m a researcher and a nerd at heart so we are collecting outcomes and trying to show, is what we’re doing working? Is our outcomes for our students, can we make them better than general statistics in the special education system which is not always serving the best interest of every kid within the special education system? I’ll say that. Can we deepen the work through tech innovation in a way that improves outcomes for kids?

    So those are the 3 buckets that drive a lot of the strategy that I have [00:38:00] in approaching the work with product, approaching the work with our clinical team, our leadership and everything else.

    Dr. Sharp: I think that’s fair. There’s so much more, even on a very concrete level, we can get so many more data points when we’re doing things within a software system, recording, auditing, action activity logs and all of that. There’s so much, even on a very basic level that we can look at that no human can track that stuff when we’re interacting with kids or administering whatever, that’s great. I love the data possibilities.

    Dr. Jordan: And I’ll say, I shouldn’t say this out loud, I am far from a Luddite. I am definitely tech savvy and I’m good at technology. That being said, I have met some of the most brilliant tech minds I have ever worked with in my life or seen or witnessed in my life.

    If I say, I would love some data on [00:39:00] eye tracking during this measure, they’ll be like, we’ll get on that. If I’m saying, let’s think through what would better outcomes actually mean and look like, they’ll think with me through what they can get through our platform, what they can collect and they have done stuff that I would never have even imagined was possible.

    I feel very privileged and I feel very lucky to be able to work with some really amazing people with great technical engineering and product minds that helped me get more creative about what we can collect and how we can use those data.

    Dr. Sharp: It’s a super cool experience. I’ve had a touch of that myself with software development over the last few years. It’s cool to get outside of our little world and interact with folks who think about things a little bit differently. The brainstorming and the [00:40:00] collaborations is really cool.

    I’m jealous you get to do it all the time. That’s the best part here. It’s funny that you mentioned the first thing that you did was automate the table creation. That is literally the first thing that we did as well with Reverb, our report-writing software, 3 years ago.

    It was like, we have to figure out these fucking tables. These are terrible. How do we stop putting scores in tables? It’s a shared pain point, that’s for sure.

    Dr. Jordan: Yeah. It’s one everyone listening has struggled with.

    Dr. Sharp: 100%. We’re in this tech realm, so maybe we talk more about this tech enablement, other technology if there’s other, if there are other things to chat about as far as Parallel and how you are empowering the clinicians to utilize technology within the platform. Are there other points to [00:41:00] touch on here?

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    Let’s get back to the podcast.

    Dr. Jordan: There are lots. I’m trying to focus this more on the assessment side for this particular audience but we do quite a bit of work around [00:43:00] making the administrative tasks of our school psychologists, our SLPs, our educators, our social workers much more user-friendly.

    We have a tool that we’ve built in that can help track IEP goals as an example. In a session, we have a sidebar, and based on whatever your goal is, if your goal is to get a student to ask a particular type of question this many times, spontaneously, you can have a little counter that you can just press every time it happens or something needing fewer prompts, we’ve got two counters, you can say they did it this time and they needed this many prompts.

    So based on what type of goal you have, we have this way of keeping track of it within the session to reduce the need for charting after the fact. These sorts of things are, [00:44:00] technologically, they’re quite interesting and savvy and take quite a bit of building even though to me, it’s like oh, it’s just this little counter. How easy is that?

    So we are trying to do that with charting, with planning. We are working toward and we have some partnerships with evidence-based curricula around social-emotional development, SEL skills around speech around treating anxiety, depression, around reading for our special education teachers, we’ve got an evidence-based science of reading curriculum around reading and writing. We’ve got math tools.

    We’ve got all this stuff that is built into our platform so that you can use it seamlessly and it allows you to spend less time prepping. It allows you to spend a lot less time getting everything ready, planning for [00:45:00] each individual kid, trying to remember what this kid like going back in their chart and saying oh, this kid, last session, last week, 35 kids ago, did this and I have to remind myself and now I have to plan this session.

    We can keep track of what happened in that last session, and that can pop up right in your new session to remind you and say what’s next in our curriculum or what more practice needs to happen based on how they did last time is this. So we can do a lot.

    We are constantly, like I said, iterating and trying to improve all of the work we’re doing with the report writer, with the tele-assessment platform, with the teletherapy side of the platform as well. We’re constantly trying to push the boundaries of what tech can enable us to do and allow us to focus and do better.

    [00:46:00] Diana: Yeah, I echo all of that. Only things I would add is they were also using technology internally to help figure out where our team should also be spending time.

    As Jordan mentioned, we have clinical managers on staff who come from all different provider backgrounds, from school psychology to speech and language therapy, special education teachers and so on, and for them to figure out where they should be spending their time, how best to support providers, they can see where are students progressing or which providers are helping students progress the most, where are things a little stuck? So being able to utilize our own resources to drive the best outcomes for students.

    Everything we build while we’ve just touched on a ton of different stakeholders who touch the product and the technology, it all comes from this general ethos of how do we drive the best outcomes for students? What that usually looks like is meeting compliance deadlines for assessment. So [00:47:00] what is the fastest we can get kids answers? What are their hurdles or barriers, and how can we work forward from there?

    And then once the student does have an IEP in place, how quickly can we help them meet those goals? As Jordan touched on, there’s so many different ways that we can support that from our hands-on support of providers, which might be tech-enabled, but then also the ways that we’re working with curriculum companies and the ways that we’re building tools for engaging those students and so forth. We’re taking a very multifaceted approach, as you can probably tell.

    Dr. Jordan: I’ll add two specific initiatives that I get really excited about. One is in all the work we do, including our assessment sessions, we use routine outcome monitoring. So we ask kids after every session, how they’re doing and how their therapist is doing so that we can get a little bit of a snapshot of, it’s like a little satisfaction survey.

    We know that [00:48:00] the research has shown that even asking kids to do this tends to improve outcomes, whether or not we even look at the data. It gives them some stake in it if they think their provider is listening to them and cares about how they feel about how they’re doing and how the session went.

    We do also look at the data. We do look to make sure that our kids are having a good experience in our online platform. We do know, everyone here knows it, that sometimes testing sessions are not super pleasant for kids. Not every kid loves sitting for an IQ test.

    Diana: It’s shocking.

    Dr. Jordan: I know. It’s shocking. Think about it, a kid who’s struggling with reading and I’m going to give them a Woodcock-Johnson or a WIAT. I’m going to tell them to read. No, that’s not fun at all.

    So we take that into account, of course, but we are using the data to help providers, to help our psychologists and our SLPs and everybody else think through the work that they’re doing. So [00:49:00] we can cut the data and think about if you’re working across the age spectrum and you are just so much better at working with little kids and they’re all loving it.

    Your high schoolers are like, I’m not feeling it. How can we support you to be better at working with the high schoolers? Maybe we need a different provider to work with those high schoolers and give you more young kids.

    We can think through using the data that we get in a way that reinforms the work we’re doing. We try and support our providers to use that data to reinform their interventions, to reinform the way they’re interacting with different types of kids, to think through it.

    And then the other thing that I get really excited about, which is again, more behind the scenes, like Diana was talking about is we have a provider support dashboard. We’re big on dashboards. We love our dashboards at Parallel.

    Dr. Sharp: I love a good dashboard.

    Dr. Jordan: Our product and engineering team will set up a dashboard to give me a snapshot [00:50:00] of where different providers are asking for support, where different providers are needing help, where they’re doing really well. We’ve got little champion buttons. We try and elevate our providers.

    Also, we want to know if every provider is struggling the first time they log into a certain test, every provider is taking 2 minutes to log into this particular test. That helps us understand:

    1. Maybe we need to go back to product and say, we need an easier way to launch this test.

    2. We need to go back to provider education and say, oh, when you get onboarded, I need to spend 5 minutes, I need to show you a video of exactly how to launch this test.

    We can intervene in those ways to reinform the work we’re doing. We think it makes it easier. We have a lot of feedback from our providers [00:51:00] but I’ve also got my own biases of what’s easy for me. I think something is going to work and make everything easier. We think our platform looks great, but there may be some things that it looks great to me but isn’t actually working out. So we try and reinform through data as much as possible, the ecosystem that we are building.

    Dr. Sharp: I love that data-driven everything. This is where we’re headed. It’s great.

    Diana: There is a tech company somewhere within Parallel, it’s clear from that answer.

    Dr. Sharp: I’m holding back from getting in the weeds on how you manage all that data, obtain it, consent, and all that kind of stuff, but we’ll just put that to the side. Maybe that’s another podcast.

    I do want to talk about the actual partnerships with the school districts, though. I asked this question in our pre-podcast chat and we can maybe lead with this. I’m curious about [00:52:00] the reception that y’all have gotten from the different districts, because I could see it going two different directions and maybe more but I’m curious about your experience so far.

    Diana: I can jump in and then Jordan, you probably have a lot of talking points here as well from your own experience jumping in on customer calls. I would say it looks really different based off of who the perspective or current customer is, and what the demographics of that district look like.

    For a small rural school district versus a large urban district, their use case for using an outsourced provider in the first place, nevertheless, teletherapy provider is going to look very different from the next. In a more rural setting, there might not be any other alternative unless that provider is going to literally fall from the stars.

    They’re probably not going to get a new school psychologist in the door when [00:53:00] it’s already October.

    That might look really different in an urban setting, but you also are dealing with much larger number of students and a large fluctuation of students being different services. And so in that sense, a solution like Parallel is incredibly flexible.

    We’ve got a number of different types of providers as you can tell under one umbrella. Our contracts are written relatively flexibly for school districts to be able to utilize their time with us in different ways.

    All that’s to say, I wouldn’t say there’s one specific school district archetype that is the Parallel customer but we see districts coming to us for all different types of reasons. Always there is an underlying challenge around staffing and we are able to ultimately solve that.

    More and more, we’re seeing districts be able to come to us especially as we [00:54:00] develop our reputation in the space as this clinically forward company is that being as we started this podcast, a better alternative to potentially hiring on the ground.

    Even all the stuff we just talked about from a data standpoint, most districts don’t have that data on their own providers. So it’s much easier when you think of the role of a special education director to be able to justify that they are doing a good job in their job. Their goal is to have kids meet their IEP goals, maybe even graduate those kids out of special education, utilize their resources as well as possible.

    And so we are looking at our relationship with school districts truly of that as a partner to be able to give them what they need to be able to go back to their superiors, but also the parents of these students and feel exceptional about the support that they are getting.

    Dr. Jordan: When I think about the different types of [00:55:00] partners, certainly they’re all over the place. We’ve got urban, we’ve got rural, we’ve got suburban, we’ve got all of that kind of stuff.

    I do think of 2 buckets of types of school partners that we end up with right now. We have those that are desperate, we have those who have staffing shortages, they’re out of compliance, they have a need that they need to fill and they are looking to staff. And that’s okay. We’re there to help.

    The others are the more innovative districts, those who actually want to innovate and think about doing better for their students. I’m thinking of a particular district we work with, for example, in a specialized school district with incarcerated youth where it’s harder to do good work in that context in-person, and we’ve found some workarounds where sometimes maybe you need a portable Wi-Fi to get them [00:56:00] online because that’s not as easy and other things like that.

    So we do have those innovative partners that are, I shouldn’t say this, they’re all fun to work with, but they’re really fun to work with. They’re more forward-thinking and forward-looking, clinically oriented partners.

    The one thing that we pride ourselves on clinically is we do try to integrate into schools and school systems. We do not necessarily want to be just an outsourced person to do some assessments and we never see anyone. We want to integrate into those eligibility meetings, into the IEP meetings, into the discussions. We love pushing in our providers to staff and faculty meetings.

    We want to partner with the school and become part of a school community so that we are not a temporary staffing solution because you’re desperate. For [00:57:00] those schools that are desperate, for those districts that are desperate, we’re fine. We will plug in, but we want to show you that we can be a solid partner.

    We want to show you that we know you could probably go to a temp agency or a real staffing type of company and probably get these 20 evaluations done but we actually want to be a partner to you. We want to show you all of the clinical potential we have to up resource you and think about improving your outcomes with your kids.

    Diana: Only add to that to say that we’re also taking, or I would say the goal is to take a lot of burden off of the district itself in the sense of all of that clinical support that we’ve touched on here is a huge win for the district. That is otherwise support that needs to be given by your on-campus staff.

    And those staff [00:58:00] providers don’t even have time in the first place to see all the students, nevertheless, then manage an outsourced provider or a new provider to the mix, and we want to take that headache off of the district and we will happily take that on.

    But even some of the ways that we’re using technology like I pointed out with the report writer, for example, being able to tailor it to district’s needs and so on. We want to make this truly seamless for district so that they are simply meeting their compliance goals, making their life easier and in the same time, making the experience for the provider who is staffed in those districts as positive as possible.

    Dr. Jordan: I want to add one thing. I can’t tell you how many school psychologists I have talked to and worked with who are this close, my fingers are very close together, to burning out. They are feeling like testing machines.

    A lot of the school psychologists that I [00:59:00] work with, a lot of our own providers, this is not why they became a school psychologist. It was not to be a robot just doing WISC after WISC after Woodcock-Johnson after Woodcock-Johnson all day long every day.

    So some of these innovative districts are calling in for backup. They’re using us for backup to allow their on-the-ground personnel to vary their workload a bit. If we can take some of the testings off of them, some of the evaluations off of them, it frees them up to do a little group with some kids and talk to them and do some therapy or do some of the other things that are not just spending their entire day testing, report writing.

    I was just saying before this podcast, I’m just finishing up a paper right now on self-care for educators and for special education support staff and providers. We know that varying up [01:00:00] the work that you’re doing can help you reaffirm your values; why you did this in the first place so that you don’t feel like that robot that day in and day out is just going through the motions and doing these assessments.

    So that’s in between the innovators and the desperate, they don’t want to lose their school psychologists, they don’t want to lose their SLPs. They want to give them a little bit of relief and we are great at pushing in and partnering with those schools and school districts to offer some of that relief and allow for that variety in what they’re doing day to day.

    Diana: One more thing to add on that, we are going back and forth at this point, but it also helps the school district a lot in the sense that if you’re on campus provider, you can double down and focus on maybe those more complex students. And getting them in depth air, then we can work with the [01:01:00] 75% of other students to just go through their re-evaluations.

    There are a lot of parts of what the district is trying to triage that are relatively easy for us to be able to take on in a limited capacity. And so it’s is also a helpful tool for the districts themselves to figure out how to best utilize their resources and make sure that all of the kids are getting exactly what they need.

    I also see this as being a really important factor with districts that might have a parent population, for example, who might not be entirely supportive of virtual. Then your on-campus school psychologist can spend time with that 25% of students who have parents who want that in-person care who might have that more complex list of difficulties to handle.

    In that sense, it’s just creating capacity and freeing up on-campus resources to go exactly where you as a special education director need them to go.

    Dr. Sharp: I got you. I was going to ask about the response from [01:02:00] parents. It’s a sidebar question as well. How do the districts present your involvement in this process? I’ll end the question there. How are parents informed and how does that work?

    Dr. Jordan: Do you want me to answer that?

    Diana: Go ahead.

    Dr. Jordan: Schools are ultimately responsible for getting consent. When we talk about getting consent for everything we’re doing, schools are ultimately responsible.

    I write a lot of white papers. For those who are unfamiliar with white papers, they’re a summary of the research. They’re not peer reviewed. They’re not any of that. I try and summarize the research to enable schools to talk about what is valid, why this is valid, to give them talking points.

    Occasionally, they’ll tag us in if they’re facing some heavy defensiveness [01:03:00] around virtual. It hasn’t happened much at all. I think parents understand the limitations. Parents want their kid to be seen. Parents want their kid to have the services that they need to have in order to succeed.

    Certainly there have been some vocal parents who are like, I don’t want this. This is terrible. That’s fine. It is ultimately up to our school partner, but we try and partner with them really well. We try and give them the white papers, give them talking points, give them what they need to have in order to advocate for doing the services the way they need to.

    Sometimes it just comes down to, do you want your kid to get services or not? We don’t have an in-person provider so your option is to do it this way or we can postpone a year and your kid will not get services for this extra year, and they may developmentally lag behind.

    That’s a terrible way to look at it, but sometimes [01:04:00] that’s the reality is that they may not have the resources to do it any other way but we’re here to partner with our schools, we’re here to jump in when we need to jump in. I’ll let parents pepper me with questions and I will push my glasses up and nerd out on them about the research and I will happily send them all of my papers or send them the tele-assessment book, which reviews all their research.

    We’ll do what we need to do. I will say we haven’t had that much pushback from families around consent or around doing it this way.

    Dr. Sharp: That’s great. Our time is flying. There’s so much we can talk about, so many side roads we did not turn down, but maybe we start to close with what it’s like being a provider for Parallel if there are any folks out there who might be interested.

    Dr. Jordan: I’ll take this one.

    Diana: I was going to send this one straight to you, Jordan.

    Dr. Jordan: Good. [01:05:00] We are trying to build a strong provider network. We don’t accept just everybody. We have a very selective set of algorithms to think about in who we partner with as our providers.

    Obviously, we offer a lot of flexibility. We work with our providers to think about how much time they can give, what time they want to give to this and in return, we try to support them in every way we can. We try and listen to them. We engage them in discussions around our product.

    Obviously, we pay for their time whenever they are meeting with our head of product who’s awesome and giving her feedback. We have monthly provider meetings where we try and highlight providers who have specific skills.

    [01:06:00] I’m thinking on our speech-language pathology side, we have one provider who is an expert in helping kids work with AACs, these devices and it is just not a skill that everybody has. And so we’re like, please talk to us about it. Upscale us.

    We are a NASP-approved CE provider. We’re NASP-approved for speech-language pathology. So we do webinars. We’re trying to build a community. It’s not perfect.

    When we hire, we can’t guarantee that we have a placement for you in a particular school or this many hours or that kind of stuff. We do try to meet you halfway around flexibility. The more you can offer us, the more we can offer you.

    Around partnering, we do try our best during the summer to engage [01:07:00] providers in little projects because we know summers are tougher if you’re not making that money. If we want to double down on improving our report writer, then we may take the summer and say, let’s get a little cadre of school psychologists together in some thought leadership work around our report writer and think about what’s out of the box stuff that we haven’t even thought about yet that you could guide us toward improving.

    We are trying our best to do well by our providers, to give them as much support as we can give them. Our clinical managers are very available and making sure that our providers are doing the best work that they can do, the most fulfilling work that they can do, knowing that, don’t tell anyone I said this, but sometimes schools are hard to partner with. Sometimes schools are not the clearest in their policies, or they are grumpy.

    I hate to say that, but sometimes schools are grumpy. [01:08:00] So we try and help facilitate those relationships the best we can. We’ve got not only our clinical team, but we’ve got a customer support team. Every single school partner that we work with has a dedicated customer support person that helps them with any tech issues, with any glitches, with any miscommunications, with figuring out how best to organize how their kids are seen so that our providers don’t have to do that.

    We’re working toward and constantly improving our providers doing the work that they should be doing. There’s always going to be some administrative, what we call indirect time that they are getting their billing for, and they’re getting paid for, but we’re trying to reduce that as much as possible through our teams, through our tech, through our product, through everything else.

    Diana: The only other [01:09:00] thing I would add was that I think Parallel is a unique journey. No matter what stage you’re at in your career, whether you’re a psychologist or a different type of provider who is joining us, we do extremely thorough onboarding for all different domains. If you’re new to the field, this is a great place to start your career and get a lot of guidance and support.

    To pimp out Jordan for a second, you get to work with Dr. Jordan Wright who’s pretty amazing, and our entire team of clinical managers who are all exceptional and have years and years of experience each independently in their domains.

    And so an incredibly exciting place, whether you’re new to your career, or if you are potentially in that more burnt out camp, and you want to get some more flexibility and be in a little bit more control than working in the district itself.

    We have providers from all different backgrounds here. We, as Jordan just touched on, want to meet providers where they’re at and make this the best [01:10:00] step in their career. And so there’s a lot of different ways the Parallel experience can go but the point being is that you’re getting a lot of support in all cases and access to some really cool people and some really cool technology and a great mission.

    Dr. Jordan: And the one thing I’ll add, just because we keep popcorning back and forth is we also value mentorship. There are mentorship opportunities on both sides. You can be a mentor and a mentee to newer providers and to our clinical managers who are great mentors. We take that seriously.

    We take professional development seriously. It’s why I did a webinar last week on neurodiversity and executive functioning and how to upskill kids in executive functioning when you’re working with neurodivergent kids. I try to do as much as I can to upskill our providers [01:11:00] and mentor them as best as I can as well.

    Dr. Sharp: That’s amazing. Y’all present a really compelling picture from top to bottom of what you’re up to over there. Thanks so much for being here.

    It’s cool to talk to both of you who I met in different contexts and bringing it all together. I love talking about tech and ways to advance our field and the work that we do, so grateful for y’all for being here to do that with me.

    Dr. Jordan: Thank you so much for having us.

    Diana: Thank you for having us.

    Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode, always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.

    If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcast.

    If you’re a practice owner or [00:12:00] aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting.

    If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call, we will chat and figure out if a group could be a good fit for you. Thanks so much.

    The information contained in this podcast and on The Testing Psychologist website are intended [00:13:00] for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

    Please note that no doctor-patient relationship is formed here and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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  • 469. Parallel Learning w/ Diana Heldfond & Dr. A. Jordan Wright

    469. Parallel Learning w/ Diana Heldfond & Dr. A. Jordan Wright

    Would you rather read the transcript? Click here.

    Join me in today’s conversation with Diana Heldfond and Dr. A. Jordan Wright, the CEO and Chief Clinical Officer for Parallel Learning. Parallel offers an ecosystem of tech tools and providers to help increase access to essential services for school-aged kids. Today’s episode covers a broad range of topics: tele-assessment, technology and AI, access, and provider burnout. Specifically, we discuss:

    • The origin of Parallel and how it’s serving a crucial need for school districts
    • Current state of the research on tele-assessment
    • How Parallel is leveraging technology in assessment
    • What it’s like to be a Parallel provider

    Cool Things Mentioned

    Featured Resources

    I am honored to partner with two AMAZING companies to help improve your testing practice!

    PAR is a long time supporter of the Testing Psychologist podcast, and I will continue to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

    TherapyNotes is the leading EHR system for mental health practitioners. I’ve used TherapyNotes for over 10 years, and it just keeps getting better. Use this link and the promo code “testing” to get two free months and try it for yourself! www.therapynotes.com/testing

    The Testing Psychologist podcast is approved for CEU’s!I’ve partnered with At Health to offer CE credits for podcast episodes! Visit this link to access current and past episodes available for CE credit. You can use code “TTP10” for a discount on ALL the course credits you purchase from At Health!

    About Diana Heldfond

    Diana Heldfond is the Founder and CEO of Parallel Learning, a technology-forward education company focused on supporting students with learning differences. Parallel provides resources and encouragement to help these students succeed in the classroom and beyond by building confidence in their strengths and creating strategies to overcome challenges. Heldfond’s goal is to simplify access to care for families, providers, and educators, ensuring that more students receive the support they deserve.

    About Dr. A. Jordan Wright

    Dr. A. Jordan Wright is Chief Clinical Officer at Parallel, leading their clinical vision for accessible, evidence-based support services for students with learning differences. He’s also a Clinical Associate Professor at NYU, directing their combined Clinical/Counseling Psychology PhD program. An expert in psychological assessment, Dr. Wright is a prolific author and researcher, emphasizing LGBTQIA+ issues and social justice.

    Get in Touch

    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

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  • 468 Transcript.

    [00:00:00] Dr. Sharp: Hello everyone and welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner and private practice coach.

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    Hey folks, welcome back to the [00:01:00] podcast. Glad to be here. If you have been a listener for any number of years, you will know that I’ve had a few guests from the practice, Thriving Minds, which is in Michigan. I started with their owner, Dr. Aimee Kotrba, talking about selective mutism, and then talked with Bryce Hella about supervision and Andrea Roth about sleep and now I have another of their employees, Katelyn Reed, talking about intensive treatment models.

    This is a fascinating conversation. It’s a model that I don’t think a lot of us probably adhere to, but after the conversation with Katelyn, it certainly got my wheels turning about what this might look like in practice. I imagine it will do the same thing for you.

    A little bit about Katelyn, she is a Limited Licensed Psychologist and the Selective Mutism Program Director at Thriving Minds Family Services, they’re in Michigan. Through her work there, she specializes in treating children with Selective Mutism via traditional weekly therapy and [00:02:00] intensive therapy as well as group therapy models.

    Katelyn is the current President of the Selective Mutism Association and co-author to the recent book, Selective Mutism: An Assessment and Intervention Guide for Therapists, Educators, and Parents: Revised and Updated Edition.

    There is a lot to take away from this. It is testing adjacent, I would say, but certainly relevant for a diagnosis that a lot of us work with quite a bit, or diagnoses, I should say, selective mutism and other anxiety related disorders. Hope you enjoy this one and without further ado, let’s get to my conversation with Katelyn Reed.

    Katelyn, hey, welcome to the podcast.

    Katelyn: Hi, thank you so much.

    Dr. Sharp: Thanks for being here. It’s [00:03:00] funny, I feel like I’m developing a pretty close relationship with your practice at this point, having had maybe four of you now. Is that right?

    Katelyn: I think I’m the fourth. Yeah, that sounds right.

    Dr. Sharp: Aimee, Bryce, who else?

    Katelyn: Andrea.

    Dr. Sharp: Andrea, that’s right. Yes, of course. The sleep episode. Y’all have star-studded staff up there. I would imagine it’s a pretty nice place to work.

    Katelyn: It really is. Yes, absolutely.

    Dr. Sharp: Thanks for being here. We’re going to be diving deep into this topic of intensive treatment options, which is super relevant for us on the diagnostic work that we do and different options for treatment for some of these kids.

    Before we get into it, I’ll ask the question that I always ask, which is, why this is important to you and why do you care about this and why have you chosen to spend most of your life on this?

    Katelyn: Maybe we should first define what intensive [00:04:00] is. So intensive, the way that I usually explain it to the families that I work with, it’s not called intensive because it’s inherently harder, but just more time intensive. Instead of taking a typical course of CBT, which might be 16, 20 visits spread out once per week, we’re usually squashing all of those sessions into the course of two days or two weeks.

    And so the intensive offering brings a lot of clinical value, meaning we see a lot of kids make more substantial gains because we can thin out some of that warmup window, we can connect families with more folks who have expertise in their child’s condition, so we can get better access, improved [00:05:00] access to evidence based interventions.

    That’s why I’m super passionate about it. I work in a pretty niche area in treating selective mutism. We get a lot of families who come from a pretty considerable distance to our clinic looking for that service.

    For us, it evolved in a natural way. We had all these families who were saying, I can’t logistically make this work to come every single week, it’s going to be a six-hour round trip thing for us. It’s really evolved beyond that point. So it’s been pretty exciting to be a part of that.

    Dr. Sharp: It is super exciting. I have a lot of questions about the logistics and how all this works, and that kind of thing. I’m curious about your background; did you start in a more traditional treatment model where you were doing the 16 to 20 session CBT thing or something similar?

    Katelyn: Yes. Definitely, [00:06:00] pretty broad background in terms of lots of different anxiety presentations, always from a CBT exposure based model. But then the intensive model, for us, came from the need of the families that we were working with. We’re working with families who were like, I have to hop on a plane. I cannot do the weekly sessions.

    And this was […] where it was a lot easier to work across state lines. We were finding we needed to be able to develop something that met the needs of those families.

    Dr. Sharp: Let’s dive into that a little bit. I would love to hear more about the practice setup, how this is integrated in the practice. I don’t know if you were around when y’all made the leap the first time. I would imagine saying, hey, we’re going to do this week of intensive treatment [00:07:00] and hopefully, people come. How do you take that leap? Any questions around that material would be great.

    Katelyn: We have several different intensive models that we offer at our clinic. I dug in a little bit to the research on what are some of the other folks out there doing? Although my practice is primarily in selective mutism, I realized that that’s not going to be your entire audience’s primary focus. So I want to try to speak to what is appropriate for those conditions too.

    We offer three different intensive models for selective mutism. We also see school refusal. We’ve seen other more specific phobias with this model too. It’s something that we are growing more and more.

    To answer your question about making that leap; my primary role is doing intensive style of treatment and absolutely, at the beginning, we would [00:08:00] get more sporadic referrals for this. And so I would try to squeeze those families in around my other sessions.

    What that meant is that I had an insane amount of sessions that week. I was doing four or five hour days for the intensive and then still having three or four hours for my other clients that I felt like I couldn’t take a break from that week or whatever.

    Even at the beginning, we were sharing our time. So they might work with me for the first four hours and then they might see Dr. Kotrba, who you interviewed some time back for the remaining two.

    Initially it was just however we could make it work schedule wise. At some point, we were getting enough referrals that it made sense for my position to evolve to that. So I don’t see barely any regular traditional cases anymore. I [00:09:00] do primarily intensive and then I also do some testing.

    Dr. Sharp: Nice. As far as the details around this; just very curious how this works; how many intensives are you doing across the course of the year? Is it multiple times? Is it a one shot deal. What’s this look like?

    Katelyn: I would say it often is a one shot deal. I might work with a family. They’ll come out for four consecutive days. We’ll work for about five hours each day. It’s my hope through the intervention that not only is the kid getting the type of exposure opportunities that they need; so for treating selective mutism, that’s talking to new people and in new places.

    I should note that with the intensive model, we can do the in vivo [00:10:00] exposure in a more successful way. We have more flexibility. If I have five hours, I can go to the park with the kid and we can practice talking to new children and simultaneously or just thereafter, we can go to the grocery store and practice asking for help locating items on our grocery list.

    We can also go and order lunch together and practice ordering their meal in a full sentence. I can get the in vivo component pretty easily there. We’re getting the kids as much practice as we can get in a short window of time, but we also want to equip the parents of the kids that come with the skills and strategies that they need to be able to replicate this.

    Because we’re targeting both exposure work with kid, parent training, parent practice, parent coaching; we’re able to, [00:11:00] for the most part, send kids away and they continue to keep up the exposure to work that they’ve been taught.

    We usually do some school training, because of the nature of this particular diagnosis, we want the educators and the administrators of the school to have a better grasp of the diagnosis and their role in supporting the intervention efforts. When we can provide that wraparound service, many folks have the foundation of what they need to be able to continue to implement it on their own.

    Some do come back. For us, that’s often switching between our intensive models. I referenced that we have three for selective mutism alone. We have folks who come to us for a clinic one-to-one intensive. They work alone with me. We start in the clinic to [00:12:00] establish speech, lay the foundation of our psychoeducation, do the assessment of their symptom profile for selective mutism. And then we progress into the community setting as well.

    We have another version where we come to the child specifically in their school environment, usually and we carry out the same evidence-based interventions. Instead of training the parent, we’re training the school or the school social worker, the teacher, whomever are the stakeholders there.

    And then we have a third model, which is our treatment camp. In the camp, we rent out a school and we time it to the beginning of the school year. The kids are in a group of other kids who are approximately their same age. It’s meant to replicate a school, so they’re being called upon and asked to read aloud and speak [00:13:00] in school scenarios.

    So we might have someone who comes for a one-to-one clinic intensive because that’s where they’re at the beginning of their treatment. And then the following year, they come back for the camp because they had some good success. They want the new school year to start off strong so they apt to come back and do that instead.

    Dr. Sharp: I’m so interested in the school model. When you say you rent a school, what does that mean? Are there actors? How are you staffing the school? How are you replicating a school environment?

    Katelyn: We literally rent out of school. We reach out to a private school in our area. We have a standing relationship at this point with one school. It’s at the end of the summer. We have to deal with some of their clean up measures, [00:14:00] but otherwise the school functions the way that we need it to; there’s a lunchroom space, there’s a recess area, there’s a variety of classrooms and everything we need.

    So then in terms of staffing, this is the much more complicated question. If we think about a school, there are principals, there are teachers and then there are behavioral aides. In the school, in our camp, there are directors or principals, each classroom has a teacher. It’s one of our licensed staff focusing in selective mutism.

    And then every child is paired one-to-one with a counselor. The counselors, we recruit primarily from local graduate school students mostly in psychology, some social work, some speech pathology, some in special education programs. So things that are tangential to our [00:15:00] pediatric anxiety world.

    We train them and then they carry out the intervention under the supervision and support of all of the folks who are specialized, who are in the room at all times too.

    Dr. Sharp: Got you. This is fascinating. We mentioned the school refusal program, the selective mutism, are there others that you’re doing in the practice or other presenting concerns that are more amenable to intensive treatment?

    Katelyn: Yeah. We acknowledge the school refusal part came a little bit later for us. Originally, we would just take what’s working for selective mutism, make some minor tweaks and changes and roll it over to the school refusal population.

    What we found is that the intensive models worked well, but [00:16:00] we needed to adjust a little bit more than anticipated because if we just took four days and got the kid into the school for four consecutive days, that didn’t necessarily mean that they were going to have the same success the subsequent week.

    There’s definitely tweaks and modifications from the different populations that we’ll see. We are only using this with anxiety at this point in time. And that’s what the research has been conducted on that, that I’ve been able to find.

    One of the things that is complicated about the research is that there’s a variety of terms, so some are calling them brief, intensive and concentrated, some of them are calling them intensive group behavioral treatments. There’s a lot of different acronyms.

    We’re seeing this start to be used with not only selective mutism, [00:17:00] social anxiety, school refusal panic disorder, and some specific phobias, separation anxiety, certainly obsessive compulsive disorder, which is, if I’m not mistaken, where this whole thing started, generalized anxiety disorder. So really a ton of utility with a pretty wide variety of populations.

    Dr. Sharp: Sure. Do we have research on intensive versus typical once a week exposure? What’s that look like?

    Katelyn: Yes. First of all, some of the research is we’re comparing this intensive model to weightless controls or we’re comparing them to non-treatment receivers. We also do have head to head comparisons with intensive versus regular form CBT, and [00:18:00] the research is telling us that we see comparable gains; effectively no change in effect size from the traditional model of CBT but that the gains might be achieved more quickly.

    So if you take 20 sessions and you squeeze them into one week, then you’re going to achieve more in that one week. We see some extra benefits that is like a return to more typical daily functioning in a quicker trajectory.

    We see some of the studies when there are comorbidities, we’re seeing more reduction in the comorbid symptoms. So if there’s comorbid depression, we’re seeing a change in that as well, even though that wasn’t the treatment target.

    The other thing, and this is out of the selective mutism research specifically is that we’re doing immediate follow up, [00:19:00] so we’re redoing some of the initial assessments immediately after they complete treatment. We’re seeing nice gains, but then we also have been following up these same families three, four months later and we’re seeing even more substantial gains. So the families are learning, they are practicing, they are implementing, and the kid continues to make progress outside of the treatment, which is really exciting.

    Dr. Sharp: Yeah, absolutely. I think that’s the thing that we’re always concerned about is how these interventions endure and if they generalize. This is great.

    Let’s get into more details around this whole process. I’m curious, where are most of the referrals coming from at this point, are they internal from your practice? Are they external from others in the city, state, country? Where are these referrals coming from?

    Katelyn: By and [00:20:00] large, they are coming from other families that we’ve worked with already. So it’s word of mouth in that way. I think the selective mutism side of this, because there’s so few specialists, there’s a lot of dedicated parent groups online and folks are doing a really good job at trying to connect families to resources because they themselves struggled to find resources.

    Mostly, we’re getting the referrals in that way for the selective mutism side, but for the school refusal cases, we’re getting more of those referrals from the partnerships with schools that we have put into motion. The school social workers are passing us as a [00:21:00] resource to these families.

    Dr. Sharp: That’s fantastic. And then what happens once they get referred? I would imagine there are some kids who are a pretty good fit, some are probably not a good fit. This falls, it feels like so far outside the typical referral stream or selection process.

    I would imagine if you admit a kid, so to speak, or accept maybe, and then they’re not a good fit, it’s even worse because you’re spending so much time with them. How’s the selection process work?

    Katelyn: It’s really unique. It’s hard to predict what the presentation is going to be like once the kid gets here. Because they’re coming for such a long window of time and often from a considerable distance, the stakes feel really high. [00:22:00] We want all of our clients to have success, but when someone’s put a lot of time, energy and money into this service, the stakes feel higher.

    Anyone who expresses interest in an intensive, we start with a 15-minute screener call. They give us a quick snapshot of their symptoms from the preliminary phone calls to our team. And then we talk them through benefits and potential difficulties with the intensive model.

    We write them an estimate for our services, I know we are planning a little bit later to talk about some of the unique costs and insurance components to this too, but we write them an estimate for the services. We talk a little bit about what types of treatment goals are most appropriate, and that helps us to narrow into either this is a good fit or [00:23:00] I think we need to try something else first before you can consider an intensive.

    Sometimes this has to do with their symptom profile or the severity of their symptoms but sometimes not. What I mean by that is there are kids for whom they look incredibly “severe” on paper. The behavioral questionnaires that we give show effectively no communication with anybody outside of their family, we get them here, and they’re incredibly responsive to intervention. They speak with me or my colleagues relatively quickly.

    There are other kids who look “mild” on paper, and are slower responders. So it is really hard. And because clinically, you have to make very fast [00:24:00] decisions about the treatment that you’re providing, you don’t get a few days or a week in between sessions to plan what’s coming next, it all does make for it to be a little bit more complex trying to find who is the right fit and why.

    So even kids who sound more severe could be a good fit. In fact, if we look back at the key tenant of prolonged exposure, giving someone the long enough of a window that they need to fully engage in the exposure and feel some of that reduction in anxiety such that they’re able to check that little progression off their list, sometimes these are kids who really need the four or five hours in one sitting to finally get to a place where they can have success speaking with a clinician. They have not made success or gains at home, even with [00:25:00] CBT clinicians, specialists in selective mutism because the session windows themselves are too short.

    So yeah, it’s hard. We want to get them on the phone calls, we want to get a sense from the families on what types of things the family is struggling with right now, and also what the family’s knowledge itself looks like referring to effectively, have they already gone through some treatment? Did the parents understand more of the diagnosis and some of the treatment strategies or are they fresh and are hoping to get an immersive experience for themselves too?

    Dr. Sharp: So you do the 15-minute screening, you figure out, you said there is some component there of deciding if someone is a good fit for individual versus group.

    Katelyn: Yes, exactly.

    Dr. Sharp: Talk me through that.

    Katelyn: [00:26:00] In clinic school where we come to the child’s school or they come to our group, and that also takes place outside of our office and the school, but here in Michigan. So effectively, if we are concerned that it’s going to take more than two hours for the child to establish speech with our clinical team, then they probably are not going to be the great fit for the group model.

    So our camp, like many camps focusing on selective mutism, we have lead in requirements, meaning we want to meet the kid before the camp starts officially, so usually they come out a day or two before. We meet with them and we establish speech with them, and we want the kid to speak at least one word to myself, let’s say, and that one-to-one counselor that we pair them with so that we know some of those hierarchy levels have been checked off before we throw them into this [00:27:00] group.

    They have to speak to their counselor, around eight or so other kids and eight or so other counselors, they’re being called upon in a group, the demands and the hierarchy steps become just much more challenging. So if we’re concerned that the kid’s not going to speak at that window of time, then we might say, with an intensive that takes place one-to-one in our clinic would be a better fit.

    There might also be times where we have a kid who is doing really well with their home clinician, they’re starting to speak in community situations and they’re having more success within their extended family. Things are moving along in everywhere except the school. At that point we might say, hey, we can come to your school or you can come to our [00:28:00] replicated school where we can give you the talking scenarios that meet the kids’ current needs.

    It’s a lot about what exposure opportunities do they need and how quickly do we think they’ll be prepared for some of the more advanced goals.

    Dr. Sharp: Got you. Okay. I would imagine there have been situations where you maybe made the wrong choice for whatever reason when you missed it, in the good direction or the not so good direction.

    Katelyn: 100%. From a good direction, if we have someone who we expect is going to be more challenging to work with, but they make really substantial gains, that’s not so bad of a situation and we can adapt and adjust to that pretty easily.

    We can find much more challenging goals. We can adjust to that really easily. It’s [00:29:00] harder when we overshoot what we think the kid is capable of, and then they have a harder time in whatever program than we expected

    Dr. Sharp: Sure. That does make sense. Let’s talk more about pre-treatment part. I would love to hear more about how you prepare the families for this experience; what that looks like, what you’re telling them, how much are you couching the anticipated effects or results.

    I have so many questions about how to prepare families for this experience, because I would imagine they build up pretty high expectations for something like this. I’m curious how you go through that specifically.

    Katelyn: I’m [00:30:00] always interested at how many families that I work with who are baffled that they’re, one of the comments that I hear frequently is I thought I was going to have flown all this way and my kid wasn’t going to talk for four days, that’s a really common sentiment. I think, yes, they’re cautiously optimistic and willing to put some money and time on the line to make that bet. I think they’re generally quite worried that the kid is not going to make really good gains.

    There’s some setup that we like to talk through for the family what to expect. So for us, that means we go through a day by day. On day 1, you’re going to arrive. I will direct you right away into our playroom space. There’s a camera system set up in there. I am just [00:31:00] trying to get a language sample of what your kid can do alone in my office but with you as parent.

    I want to see what their language looks like at baseline so that I have a sense of where I’m starting and what I’m starting with from a treatment strategy perspective. That’s what the direct observation portion is going to look like.

    After that, we’ll sit down, me and you parents, we’re going to talk about your observations, my observations, what those mean for treatment. We’re going to set some more defined goals together. I’m going to ask some additional questions about the paperwork that you shared in advance and your kid’s symptom profile.

    And then usually we take a break for lunch and when you come back, the rest of that afternoon, we’re typically focused on those early exposure goals in my practice; establishing speech with me. And then I want to give your kids some psychoeducation about why we are going to be [00:32:00] asking them to do these things.

    Some families find that they need a little bit more information for the kid so I’ve made two social stories that they can pass along, edit and adjust there like we’re going to go to Michigan. Are we going to fly? Are we going to drive? They draw it out on their pictures.

    We’re going to be earning prizes for working hard on being brave. Here’s some prizes that I would like to earn so they can work on that together. That we’re going to meet Miss Katelyn. She’s going to help us be brave. We’re going to get to practice in different places. Where are some places that I want to practice? That’s some of the education that the families will give to the kids.

    Education for the families is incredibly important. As we’ve built this out more and [00:33:00] more, we’ve found that we don’t want families to come totally novel because it’s really hard to establish speech with a kid who doesn’t talk to new people unless we can keep them talking to someone that they do speak with.

    So if we can keep them talking to their parent, then we have an easier way of edging into that interaction. That’s a more comfortable exposure hierarchy for many kids than having to start from the ground up and work on saying sounds and doing all these things with an unfamiliar person.

    And so we do need parents to be, I certainly don’t expect them to be like expert level clinician, but I do hope that they have some preliminary information. And so because of that, [00:34:00] we created a little video bundle that helps prepare the families for the experience.

    There’s an introductory video that describes the condition and the basics of our intervention. There are videos illustrating us demonstrating the strategies that we’ve gone through and coded. So at the bottom the family can see, oh, they asked this question and here’s why. They waited five seconds for the kid to produce a verbal response.

    They can see the strategies live, but we also have videos of us doing things wrong so that they can go through and make the point to be thinking critically about the types of questions they’re going to be asking and how to elicit speech.

    Since we started doing that, I have certainly found that the families come a little bit better prepared [00:35:00] for what their role is in supporting things and also more realistic expectations of this is what my kid might be capable of. Of course, it varies from child to child.

    Dr. Sharp: Of course. Okay. This is so nice to hear concrete details about how you tackle some of these things with families.

    As far as the kids, you mentioned the social stories and some information around that. I feel like I have to ask, it seems like it’d be hard to convince a child to participate in something like this; having had a daughter who had some school refusal and now is working through some OCDish kinds of stuff, I know firsthand, getting kids to engage in exposure is challenging [00:36:00] sometimes. How do you talk to the kids? How do you navigate if they get there and then don’t want to do it? What’s that whole process look like?

    Katelyn: That is definitely tricky and that’s one of the things that is discussed a lot in the research is how palatable is this to families. Specifically, this intensive, I’m doing this, I’m committing to this. I don’t have to try one or two sessions and see how I feel about it and I can just continue, we’re committing to the several day long experience.

    The short answer is we try really hard to couch these practices into things that are really enjoyable and really fun. And then there’s a reward system in place as [00:37:00] well. It varies substantially depending on the age of the kids. So the young kids, a social story tends to go a long way.

    Honestly, the younger children, if you do it well, you can get them through the first two exposures before they even realize that they’re doing exposure. And then you can do the psychoeducation, you can say, I’m wondering, on a scale of 1 to 5, how hard you thought it was going to be to talk to me today, and how hard is it actually?

    Usually, they’ll report a reduction, from 4 to 2 or whatever. And so you’re able to say, look, you’ve already done it. Oh my gosh, I’m so proud of you. You’re already starting to see how this is working.

    The older ones, we do provide some additional details. Obviously, parents are the consent providers, but we do provide a written [00:38:00] assent document that describes here’s what exposure therapy is, here’s why we’re asking you to do this, here’s what it’s going to look like, here’s your role, here’s your parents’ roles. We want you to do your best, that’s all we can ask of you.

    We are also going to, as anybody who does exposure work would tell you, we’re going to make sure that we’re not asking you to do the things that are too hard. We’re going to have an inappropriate plan B or plan C at the ready.

    Dr. Sharp: That makes sense. This is good work. So they’ve gotten there. They’re going through the whole thing. You did talk a bit about how parents are involved. Can you say any more about, what are parents doing during these four days that kids are training?

    Katelyn: We need them for the exposure. We need them to establish speech but [00:39:00] then, like I said, these are predominantly families who live pretty far from us so we’re not able to see them on a regular basis. We do want the parents to learn the strategy.

    Typically, the week starts where I’m at the helm. I am leading the exposures and I am coaching parents and telling them why I’m doing what I’m doing. We always save some time at the end of every day usually for a parent debrief, we talk about what went well, what didn’t go so well, set plans and goals for the next day, et cetera.

    And then as the week progresses, the intention is to hand more and more over to the parents to say, okay, we’re going to go to the grocery store next. Here’s the grocery list. The first two employees that we talked to, I want you to tell them this and this. The kid’s exposure goal is to say, da, da, da.

    And so [00:40:00] we want to be able to hand more of the exposure work over to the parents so that:

    1. The family feels more competent in carrying this out.

    2. That the kid doesn’t leave the intensive week thinking I only do that for this clinician or only because I was in Michigan, we want them to see the continuity as well.

    Dr. Sharp: Okay. That’s fair. Gosh, what else? There’s so many details. What am I missing? Oh, what about the age range? I’ve actually wondered about that throughout our conversation. What kids are appropriate for this kind of thing?

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    Katelyn: That’s a great question. We start with relatively young kids. I have a kid right now who I’m going to their daycare next week who just turned three. So quite young children. For selective mutism specifically, we need the kid to be in a school like environment for at least one month before they can get the diagnosis. So that limits things, so we’re generally not working with one and two year olds as a result of [00:43:00] that.

    And then we work with teens as well and some even young adults whose symptoms negatively impact them in the community setting, but they understand what treatment looks like and are committed to it. So really wide range.

    Dr. Sharp: That sounds good.

    Katelyn: Most are early school age, though, I would say is our primary. That’s when symptoms are usually first apparent, it’s hard for teachers to assess these kids’ skills, and so there’s a lot of motivation to figure out how to support them more.

    Dr. Sharp: Okay. We’ve hinted at the billing process a little bit. I am curious about that and the logistics; how this works. Is there insurance involved? Is there not insurance involved? [00:44:00] What does that look like?

    Katelyn: We take insurance. We’re very clear to the families that we work with that insurance will cover some, but not all of the service fees. That’s because we’re still using the same 60-minute treatment codes; we’re not a hospitalization setting, we’re an outpatient clinic and so we’re using the same regular treatment codes that I’m guessing everybody else in this audience uses as well.

    We do intake codes and we do some of the assessment codes for the direct observation time and then we write a report for them as well. So we’re using those codes too. Often how it works is because day 1 is primarily the assessment piece, we’re able to get most of day 1 covered from their insurance if they have an insurance that we participate with. [00:45:00] And then usually beyond that, it’s one treatment hour of the 4 or 5, and then the rest is patient responsibility.

    I certainly wish that that would change because I think know from the research that prolonged exposure is really important and really necessary for some clients. We’ve got a growing research base to suggest that this intensive model is equally effective, interferes less with family’s lives and schedules and yet, that’s just not the reality of the billing right now.

    Dr. Sharp: Sure. I imagine that you’re talking with families about this ahead of time to make sure they’re educated make right choices.

    Katelyn: Correct. We give them an estimate that says here’s what [00:46:00] we found that your insurance will cover, you have a whatever percent copay or coinsurance or whatever. We give them a pretty close as we can get estimate to what their portion will be.

    And then in order to be able to book their intensive time, they put a deposit down, because we’re reserving 20-something hours worth of time for a family at a window of time. So they put down a deposit and then we account for what we expect their insurance will pay.

    Dr. Sharp: Right, that gets into questions about no show fees or canceled. What if somebody gets sick at the last minute, how do you handle something like that with when you’ve got 20 hours reserved?

    Katelyn: I was doing this at the beginning of COVID too, and so we did have to like, it was a whole thing.

    Absolutely, if someone was sick or had an [00:47:00] exposure, we had to have a pivot plan, which really at that time was we will let you reschedule X amount of times and then otherwise, please don’t let us get to that point. Hopefully we don’t get to that point. We thankfully didn’t.

    We have had kids who the family emails us frantically the weekend that they were supposed to fly out saying our service starts on Monday and my kid is throwing up and we’re not going to be getting on a plane. So that’s happened. We try to be flexible with that. There are things that happen.

    It is really hard from the clinician’s perspective, because if someone has a no show for their one session because the kid is sick, you still have your full case load the rest of the day. You’re still making money. You still have things to do. You’re not paying for child’s care that you don’t end up using. [00:48:00] It’s a little harder with the intensive in that way.

    Dr. Sharp: Absolutely. Oh my gosh, it’s challenging.

    Katelyn: It doesn’t happen frequently though.

    Dr. Sharp: Okay. Fair enough. Did you have to do any unique or direct or specific conversations with insurance panels to get “permission” to bill all of these non-covered hours, or that’s just the deal, we know insurance panels do not cover multiple treatment sessions per day.

    Katelyn: Correct. No, but effectively how we write the estimate is we can’t submit these to your insurance. This X amount of time is not billable. In our camp, there are some of the service fees that are like, we rent out this space, we have to train other clinicians, we have to buy the [00:49:00] materials to be able to provide rewards every day for all of these kids. So there are some service fees that are never going to be sent to insurance. The insurance doesn’t even know they exist effectively.

    And then some families are able to, let’s say, we’re out of network with their particular insurance provider, they will seek reimbursement and they’ll ask us for documentation to support that as well.

    Dr. Sharp: Sure. Of course. What about the personal side of this? I’m just thinking times in the past, when I’ve done in-person events or multi-day events where you’re on for most of the day, how does one handle the emotional side like managing your energy, preparing, what’s that look like?

    Katelyn: Yes, [00:50:00] that is tricky. First of all, it was a lot harder at the beginning when I didn’t have my schedule dedicated in this way, because if I was seeing other clients or leaving the camp and trying to go back and do an intake for something else that I had the next week, it is incredibly hard to keep up your energy and momentum and the sharpness clinically all that window of time.

    I think now, because that’s pretty much all I’m doing in a single day, I don’t find that it’s much different from my other colleagues who might see five or six clients in one day, I’m just seeing the same client for five or six hours. So I don’t find that part now is much more complicated.

    What is sometimes hard is, so the intensive format lends [00:51:00] itself pretty naturally to people wanting to come during times where their kids are off school, they have more flexibility scheduling wise. So in the summer, I might have back to back intensive weeks, and that is tough to be on it for so many weeks in a row.

    When you’re writing a report for each of these kids and you’re having to score all their questionnaires, just as much as we want the families to prepare for their time to make it as effective as we can make it, we as clinician needs to be pretty well-versed on this kid before they arrive in my office. So that’s tough trying to keep over several weeks.

    Dr. Sharp: Yeah, of course. I would imagine hopefully, you have some flexibility to say, hey, I’m only going to do three of these or something like that.

    Katelyn: Yeah, correct. I do [00:52:00] try to schedule my time in that way. And then because each of these intensives, like I said, we do a school consultation after they return home and are settled as well, I have to budget sometime, even in the summer for flexibility to schedule those types of follow ups as well.

    Dr. Sharp: Of course. Are there other, I don’t know if you’d say downsides, but challenges from more of a personal energy management standpoint or emotional standpoint with a model like this, things that are tougher to manage for you as a clinician?

    Katelyn: Yeah. One of the things is the pivoting for the plan Bs and the plan Cs if things don’t go the way that you expect. What’s nice about this model with selective mutism in specific is that I can tell [00:53:00] pretty readily if what I’m doing is effective because the kid is talking or they are not talking. I see pretty quick results from the exposure which gives me the chance to pivot my strategy pretty fast if I need to.

    Kids are kids, sometimes they wake up cranky or they had a tough exposure earlier and they’re feeling sleepy now and one thing that goes wrong can set the whole day back. It can really be a problem.

    On the other hand, and this is why I love intensive format, if a kid has 5 successful practices in a row, we can usually get them to do a 6th [00:54:00] practice because what’s a 6th practice if I just talked to 5 new people.

    Let’s say it’s a separation anxiety case, we just did that practice and that practice, I can do this much harder practice for a longer window of time away from my parents or from a further distance away from my parents or whatever the exposure task is because I’ve already had all this success. But if things aren’t going great on one day, it almost feels like the whole day can go downhill pretty fast.

    Dr. Sharp: Yeah, I think that’d be pretty tough. We have all struggled with that even if we’re testing a kid and hanging out for 4 or 5, 6 hours a day and something goes wrong in the morning and it’s like oh, no. You just buckle up and pull out the tricks and hope that …

    Katelyn: I think in some ways, that’s why there are so many parallels to the testing role and this intensive role of [00:55:00] schedule wise, we’re talking about a lot of the same variables, how much time you’re allocating for these cases, which hours you’re working with these kids.

    I think that it’s a nice companion for folks who do a lot of testing and want to have some treatment cases but maybe don’t have the bandwidth in their schedule to do that on a regular basis.

    Dr. Sharp: Sure. That makes sense. That might be a nice segue into if folks out there wanted to, I’m about to say, give it a shot, this doesn’t seem like a thing you just give it a shot, there’s a lot of planning and organization. Can you identify even two, three steps to take if somebody is listening and they’re like, I want to do this. How do I do this?

    Katelyn: I’m [00:56:00] talking pretty exclusively about exposure therapy and specifically about anxiety work so obviously, step 1 is having the competence in that. Like I said, our treatment camp, we draw upon mostly psychology students but we definitely have providers who are already licensed and practicing and looking to get more experience with the intensive model or selective mutism specifically. They’ll come and do the camp. They’re paired with a kid. And so that’s a great way to get a feel for the intensive model and also to do it with the guidance and support of our team.

    And then I definitely, this is more applicable for the folks who are somewhat in proximity to our clinic, but we have a lot of folks who come in and shadow for the day or for two days which is a [00:57:00] mutually beneficial situation; they get the learning experience that they were hoping for, they get to participate in intensive and see all of the various components, the parent education and the coaching and the skills themselves, and I get another person for this kid to practice with that I need as well. I think that is probably the most effective way to do it.

    Dr. Sharp: Nice. We should have talked about this at the beginning, but what is the role of assessment in this whole process?

    Katelyn: We’re not doing structured assessments in the way that we would for ADHD or autism or things of that nature. It’s more of, does this seem like a good clinical fit for their needs. Like I said, we’re doing a lot of behavioral questionnaires. [00:58:00] Some of them are broad anxiety screeners. Some are much more narrow into the selective mutism symptoms.

    Some are things that we’ve made ourselves that are just like, I find myself asking the same question about will your kids speak to this person in front of other people, only alone? Do they whisper? So more of check the box sort of scenarios. So all of that can be really helpful. With the older kids, we’ll give examples of SUDS hierarchies scenarios and we’ll ask them to help us to arrange them.

    So as much as we can do at the onset to prepare for the treatment, the better. We have had kids who end up doing more comprehensive testing with us as well. They come in for the [00:59:00] selective mutism treatment and then we find either through the intensive treatment or posts that there are also indicators of ADHD or autism or whatever else.

    There’s a concern about whether the child will speak with the clinician to be able to do the evaluation procedures. So sometimes they’ll come back to us because they were already able to have success verbalizing with us. Generally, it’s more of a direct observation and behavioral questionnaires.

    Dr. Sharp: Yeah, that sounds good. I know we talked about the referrals and where the referrals are coming from. It sounds like it’s a lot of word of mouth, which is great. Are there other ways that y’all are actively marketing this service and getting those referrals through the door?

    Katelyn: Yeah, we’re a part of [01:00:00] some of the organizations that support CBT and other evidence based practices. That’s something that we spend a lot of time collaborating. We speak at conferences and trainings and such like that.

    We do a lot of collaborating with local schools and pediatricians; things of that nature as well. Most of the referrals are coming from other families that we’re working with and dedicated groups focusing on X, Y, Z diagnosis.

    Dr. Sharp: Sure. I would imagine, once the ball gets rolling with something like this and people hear about it, then it gains steam pretty quickly. Do you have any sense of how many of these programs are out there in our country at least?

    Katelyn: Oh, that’s a really good question. [01:01:00] I’m a part of the selective mutism association and there are a number of group treatment camps. At one point, I had a list of all of those. Of course, I don’t know those numbers off the top of my head now but they’re spread out.

    Of course, that’s me being naive about the other areas of expertise; if you’re doing more OCD intensive work or panic disorder intensive work. I don’t pretend to know all of those groups either. I think that it’s more rare, but also even in the last 10 or so years that I’ve been doing this, it is exponentially growing.

    And for the reasons that we started this discussion with; families are having trouble finding a provider that does evidence [01:02:00] based intervention and that has a specialty in their area of focus. It’s hard for them to get to regular treatment sessions or the regular treatment sessions are limited by some of the rules or the confines of that setting. If you only have one hour, it’s pretty hard to go out into any real life places to practice. So yeah they’re definitely increasing.

    Like we said, with the research saying that it’s equally effective and then sometimes having extra benefits that the families and the kids are endorsed seeing, I wouldn’t be surprised if it continues to grow.

    Dr. Sharp: Sure. I had one more question for you around this, but now it’s escaping me.

    Katelyn: It happens.

    [01:03:00] Dr. Sharp: Thanks. We’ve talked about a lot of things with this method of treatment. It’s really fascinating. I love the idea of diving in there and doing such intensive treatment. That reminds me of the question that I was going to ask, which is, liability and releases of information and that sort of thing. To be going out in the community and doing this in vivo work, what does that look like just from a logistical kind of paperwork standpoint?

    Katelyn: That is a really good question. I think we think about that; those ethical variables no matter if it’s intensive versus if it’s a non-intensive. If you’re doing anything where there’s potential risk of being overheard that there’s some extra complexity to that. So we include that in our informed [01:04:00] consent.

    Especially when I’m having somewhat a shadowing clinician or one of our practicum students or a doctoral intern that’s coming in for a part of the time to support, I think most families are fully in support of having additional people join us. For selective mutism specifically, we need extra people to talk with. So there’s no ambiguity about other people are going to be involved in some capacity.

    Dr. Sharp: Got you.

    Katelyn: One of the things that we do have to be careful about as clinicians is setting up exposures that involve novel people and not helping them to understand what their role is going to be without telling anything that is not okay to [01:05:00] say.

    What I mean by that is I couldn’t go up and say, hi, I’m so grateful that you’re willing to help us. My friend here has selective mutism. They need to practice talking to somebody new. I can’t do any of those types of things.

    It is an awkward social exchange if you have a client who’s not readily speaking to somebody new or the practice doesn’t go the way that you planned and you have to go back and do a plan B or a plan C.

    There are definitely times where people will say, oh, are you family or oh, wow, is this your teacher? Having some stock statements at the ready how to navigate those situations.

    I find, in terms of how I set those up, I don’t even say anything. I would just go over and say, oh, my friend is trying to decide between ordering the chocolate ice cream or the vanilla ice cream; would [01:06:00] you mind asking them which one they want?

    And then I have to shoulder some of the discomfort of telling a grownup how to ask a question and hope they don’t give me too weird of looks. And then I move on with my day and hopefully, I never see them again or they don’t remember me.

    Dr. Sharp: Right. You just have to go for it and get over it. Got you. This is great. This is fascinating. I love these out of the box practice models. I think it’s a great option for us just to keep in mind too, for families when we’re working with them.

    Katelyn: Absolutely. I do some assessment and so being able to refer people to this model or the weekly model or both, being able to help families navigate what might make most sense for [01:07:00] them.

    I’ll give you an example of that. We do get a lot of folks who are referred to our camp. Like I said, the camp goals are a little harder and a little higher because of the nature of the group model. And so there are times where we’ll see on recommendations reports, you really need to do a camp and that kid might not be ready for that camp or might not make as good of gains.

    I think it’s an interesting thing to speak about because the research is increasing in this area and being knowledgeable about what exists out there, but also when we’re recommending service models for folks, having some of the background of who’s going to fit and why, and what does this actually look like in practice?

    Dr. Sharp: Right. That makes me think, maybe we talk just a little bit more about [01:08:00] exclusionary criteria, so to speak. So if we’re in that situation to possibly make a referral, who should we maybe think twice before sending that direction?

    Katelyn: Like I said before, until you see the kid and you see how they’re responding to treatment, it is hard to predict some of that. I think maybe the synopsis is like lots of comorbidities that might be a situation where a one-week intensive, I guess just being realistic about what the aims would be, like the scope of the intensive is going to be this and this goal. We’re not able to tackle all of these things in this one [01:09:00] week.

    I think that that’s really important for families always to know is that this is not a curative week. Most people find that they learn a lot, their kid makes really good progress, they have what they need to continue to implement this as they move forward in their day-to-day lives, but it’s not curative. So being able to set the right expectations.

    High comorbidities would potentially be a bit of a concern. In the camp model because we’re pairing kids, are matching kids into age cohorts, if someone has some developmental or cognitive complexities that would make it so that they have difficulty in that group being able to meet the needs of the education that we’re providing in the group, [01:10:00] that would be potentially a concern.

    Certainly, this is not the type of model where folks, parents get to have a hands off scenario, they’re really immersed in this as well. I think that’s an important expectation that we would want families to have too.

    Dr. Sharp: Yeah, that makes sense. Cool. I appreciate you talking through all of this. Is there anything else maybe that we’ve missed or you want to highlight before we start to wrap up?

    Katelyn: No, I don’t think so. I really like it. It’s nice, I get to have mostly daytime appointments. It gives me the flexibility.

    It’s great to not just sit in an office all day. You get to be out about in the community and doing interesting things. I get to go to [01:11:00] museums and parks and get snacks that I enjoy also. It’s a fun way to spend the day by and large.

    Dr. Sharp: That does sound pretty good. You get out in the community, order some ice cream, apparently.

    Katelyn: Exactly. Lots of ice cream ordering and/or other treats. That’s usually one of the first exposures we do, get some practice talking to somebody new, get the nice natural reinforcement of ice cream cone, win- win.

    Dr. Sharp: It’s hard to beat that. Yes.

    Katelyn: Yeah. So it’s really awesome work.

    Dr. Sharp: It sounds like it. It’s got me interested in it. I appreciate sharing all of this with us. If folks want to learn more or connect with you, ask more questions; are you open to that? And if so, what’s the best way to get in touch with you?

    Katelyn: Yes, definitely. Certainly, you can find me [01:12:00] on the clinic website. Our clinic is Thriving Minds Behavioral Health. We’re in Michigan. My email, is that okay to provide on here?

    Dr. Sharp: Yeah, if you’re okay with it.

    Katelyn: Okay. Yes, I don’t have a problem with that. My email is kreed@thrivingminds.info. Another great

    resource, if you’re interested in the selective mutism side of things is the Selective Mutism Association. There’s some really great downloadable, printable resources there. We have a YouTube channel as well, some really awesome prerecorded talks for professionals and for families and caregivers. So really good mix of things.

    Dr. Sharp: That sounds great. I appreciate it, Katelyn. Thanks for coming on and talking through this somewhat unique and cool treatment approach that could be relevant for a lot of us.

    Katelyn: Thank you so much for having me. I [01:13:00] appreciate it.

    Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode, always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.

    If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.

    If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting.

    If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a [01:14:00] pre-group phone call, we will chat and figure out if a group could be a good fit for you. Thanks so much.

    The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis or treatment.

    Please note that no doctor-patient relationship is formed here and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you [01:15:00] need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with an expertise that fits your needs.

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  • 468. Intensive Outpatient Treatment Models w/ Katelyn Reed, MS

    468. Intensive Outpatient Treatment Models w/ Katelyn Reed, MS

    Would you rather read the transcript? Click here.

    Katelyn Reed from Thriving Minds, a group practice in Michigan, is here to talk with me about their intensive treatment model for a variety of anxiety-related disorders like selective mutism and school refusal. While not directly assessment-focused, the episode is great for those of us with multiple service lines in our practice and for anyone working with kids who might benefit from an intensive approach. These are a few areas that we dive into:

    • Research support for intensive treatment vs. extended treatment
    • Screening and preparing clients and families for this model
    • Billing for this approach to treatment
    • Marketing and referrals for intensive treatment

    Cool Things Mentioned

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    About Katelyn Reed, MS

    Katelyn Reed, M.S. is a Limited Licensed Psychologist and the Selective Mutism Program Director at Thriving Minds Family Services, located in Michigan. Through her work at Thriving Minds, Katelyn specializes in treating children with Selective Mutism via traditional weekly therapy, intensive therapy (i.e., 15-20 hours of treatment in one week), and group therapy models. Katelyn is the current President of the Selective Mutism Association and co-author to the recent book, Selective Mutism: An Assessment and Intervention Guide for Therapists, Educators, and Parents: Revised and Updated Edition.

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    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

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